Provider Demographics
NPI:1629016621
Name:ENGDAHL, PATRICIA S (LCSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:S
Last Name:ENGDAHL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:SIRAGUSA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:105 HUBBARD LN
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:ME
Mailing Address - Zip Code:04364-3867
Mailing Address - Country:US
Mailing Address - Phone:207-413-4718
Mailing Address - Fax:
Practice Address - Street 1:444 MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-6737
Practice Address - Country:US
Practice Address - Phone:207-413-4718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC4348104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME800005271Medicare PIN