Provider Demographics
NPI:1659391886
Name:LORD, ERVIN W (LCSW)
Entity Type:Individual
Prefix:
First Name:ERVIN
Middle Name:W
Last Name:LORD
Suffix:
Gender:M
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:PO BOX 6400
Mailing Address - Street 2:
Mailing Address - City:CHINA VILLAGE
Mailing Address - State:ME
Mailing Address - Zip Code:04926-0400
Mailing Address - Country:US
Mailing Address - Phone:207-649-1098
Mailing Address - Fax:
Practice Address - Street 1:60 FRONT ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-6658
Practice Address - Country:US
Practice Address - Phone:207-649-1098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC6939101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431642699Medicaid
ME431823900Medicaid
ME431823900Medicaid