Provider Demographics
NPI:1568400067
Name:DOSTIE, ELIZABETH M (LCSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:DOSTIE
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 1:93 SILVER ST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-5923
Mailing Address - Country:US
Mailing Address - Phone:207-873-2330
Mailing Address - Fax:207-873-3795
Practice Address - Street 1:93 SILVER ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-5923
Practice Address - Country:US
Practice Address - Phone:207-873-2330
Practice Address - Fax:207-873-3795
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELCSWLC71761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432092199Medicaid