Provider Demographics
NPI:1659383081
Name:DEVINS, LARAINE FLANDERS (LCSW)
Entity Type:Individual
Prefix:
First Name:LARAINE
Middle Name:FLANDERS
Last Name:DEVINS
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 1:64 PAYEUR CIR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073-5267
Mailing Address - Country:US
Mailing Address - Phone:207-324-1870
Mailing Address - Fax:
Practice Address - Street 1:863 MAIN ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-3529
Practice Address - Country:US
Practice Address - Phone:207-459-6057
Practice Address - Fax:207-459-6051
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC86881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM9611Medicare PIN