Provider Demographics
NPI:1578862074
Name:TRASK, TAMMY (LADC/LCSW)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:TRASK
Suffix:
Gender:F
Credentials:LADC/LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 234
Mailing Address - Street 2:
Mailing Address - City:GARDINER
Mailing Address - State:ME
Mailing Address - Zip Code:04345-0234
Mailing Address - Country:US
Mailing Address - Phone:207-624-1959
Mailing Address - Fax:
Practice Address - Street 1:160 WATER ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:ME
Practice Address - Zip Code:04346-5106
Practice Address - Country:US
Practice Address - Phone:207-624-1959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-23
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC4810101YA0400X
MELC150211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)