Provider Demographics
NPI:1477073237
Name:SWERI-FAKHOURI, LATIFA IBRAHIM (LCPC-C)
Entity Type:Individual
Prefix:MRS
First Name:LATIFA
Middle Name:IBRAHIM
Last Name:SWERI-FAKHOURI
Suffix:
Gender:F
Credentials:LCPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 SILVER BROOK CIR
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-8469
Mailing Address - Country:US
Mailing Address - Phone:267-441-7800
Mailing Address - Fax:
Practice Address - Street 1:175 LANCASTER ST STE 218A
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2451
Practice Address - Country:US
Practice Address - Phone:207-669-7580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-22
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL4795101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health