Provider Demographics
NPI:1497853410
Name:ROBITAILLE, MEREDITH JANE (LCPCC)
Entity Type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:JANE
Last Name:ROBITAILLE
Suffix:
Gender:F
Credentials:LCPCC
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:JANE
Other - Last Name:MCLEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:480A TURNER ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210
Mailing Address - Country:US
Mailing Address - Phone:207-577-2634
Mailing Address - Fax:
Practice Address - Street 1:1155 LISBON STREET
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04241
Practice Address - Country:US
Practice Address - Phone:207-783-9141
Practice Address - Fax:207-783-4660
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL3144101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health