Provider Demographics
NPI:1497087944
Name:ALBERT-DEHETRE, PATRICIA MARY (LCSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MARY
Last Name:ALBERT-DEHETRE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:MARY
Other - Last Name:ALBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:PO BOX 626
Mailing Address - Street 2:
Mailing Address - City:SABATTUS
Mailing Address - State:ME
Mailing Address - Zip Code:04280-0626
Mailing Address - Country:US
Mailing Address - Phone:207-784-2460
Mailing Address - Fax:207-782-2424
Practice Address - Street 1:1038 SABATTUS ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-3340
Practice Address - Country:US
Practice Address - Phone:207-784-2460
Practice Address - Fax:207-782-2424
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC3748101YA0400X
MECCS4460101YA0400X
MELC11382101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)