Provider Demographics
NPI:1518218692
Name:HARDACKER, ALYSSA LYNNE (LMSW-CC)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:LYNNE
Last Name:HARDACKER
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:LYNNE
Other - Last Name:ST. PIERRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:901 WASHINGTON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-2842
Mailing Address - Country:US
Mailing Address - Phone:207-871-1200
Mailing Address - Fax:207-871-1232
Practice Address - Street 1:64 LISBON ST STE 1
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7116
Practice Address - Country:US
Practice Address - Phone:207-871-1200
Practice Address - Fax:207-871-1232
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-28
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC137291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical