Provider Demographics
NPI:1467178772
Name:DUTIL, SAVANNA (LMSW-CC)
Entity Type:Individual
Prefix:
First Name:SAVANNA
Middle Name:
Last Name:DUTIL
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 SILVER ST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-5923
Mailing Address - Country:US
Mailing Address - Phone:207-877-9435
Mailing Address - Fax:207-873-3795
Practice Address - Street 1:93 SILVER ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-5923
Practice Address - Country:US
Practice Address - Phone:207-877-9435
Practice Address - Fax:207-873-3795
Is Sole Proprietor?:No
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC21739104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker