Provider Demographics
NPI:1487671137
Name:ASH TANCREDI, SHARON LOUISE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:LOUISE
Last Name:ASH TANCREDI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1734
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04070-1734
Mailing Address - Country:US
Mailing Address - Phone:207-879-8909
Mailing Address - Fax:207-883-5456
Practice Address - Street 1:56 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-4828
Practice Address - Country:US
Practice Address - Phone:207-879-8909
Practice Address - Fax:207-883-5456
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC57881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME153616XXOtherPREFERRED CARE
ME022448OtherANTHEM
ME22001001OtherCIGNA
ME9357960OtherPHCS
NE14Y007426ME01OtherBHN
ME7643480OtherAETNA
ME3837221OtherAETNA
ME9357960OtherPHCS