Provider Demographics
NPI:1619296159
Name:FLORES, ANITA HELENA (MA, CCC-SLP, LCPC)
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:HELENA
Last Name:FLORES
Suffix:
Gender:F
Credentials:MA, CCC-SLP, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:CORNISH
Mailing Address - State:ME
Mailing Address - Zip Code:04020-3115
Mailing Address - Country:US
Mailing Address - Phone:207-625-4525
Mailing Address - Fax:
Practice Address - Street 1:100 MAPLE ST
Practice Address - Street 2:
Practice Address - City:CORNISH
Practice Address - State:ME
Practice Address - Zip Code:04020-3115
Practice Address - Country:US
Practice Address - Phone:207-625-4525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC953101YP2500X
MESP277235Z00000X
FLSA 10238235Z00000X
TX105367235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME131370100Medicaid
ME131380099Medicaid