Provider Demographics
NPI:1497841985
Name:DENNEN, NICOLE H (LCSW)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:H
Last Name:DENNEN
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 1:7 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04021-4057
Mailing Address - Country:US
Mailing Address - Phone:207-409-4717
Mailing Address - Fax:
Practice Address - Street 1:7 BROOKSIDE DR
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:ME
Practice Address - Zip Code:04021-4057
Practice Address - Country:US
Practice Address - Phone:207-409-4717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC59321041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME041054Medicare UPIN