Provider Demographics
NPI:1598719692
Name:LAVIOLETTE, LAURIE E (LCSW,CCS)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:E
Last Name:LAVIOLETTE
Suffix:
Gender:F
Credentials:LCSW,CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 RICHARDSON RD
Mailing Address - Street 2:
Mailing Address - City:ORRINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04474-3924
Mailing Address - Country:US
Mailing Address - Phone:207-852-8000
Mailing Address - Fax:
Practice Address - Street 1:75 STATE ST
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1923
Practice Address - Country:US
Practice Address - Phone:207-667-9101
Practice Address - Fax:866-706-0381
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC57211041C0700X
MECCS3850101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM8980Medicare ID - Type Unspecified