Provider Demographics
NPI:1497056550
Name:PRESCOTT, AMANDA VANESSA (LMSW-CC)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:VANESSA
Last Name:PRESCOTT
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 1:700 MOUNT HOPE AVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5691
Mailing Address - Country:US
Mailing Address - Phone:207-941-2952
Mailing Address - Fax:207-941-2955
Practice Address - Street 1:700 MOUNT HOPE AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5691
Practice Address - Country:US
Practice Address - Phone:207-941-2952
Practice Address - Fax:207-941-2955
Is Sole Proprietor?:No
Enumeration Date:2010-11-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC127921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical