Provider Demographics
NPI:1659438331
Name:LIBBY, GAIL MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:MARIE
Last Name:LIBBY
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 1:300 PROFESSIONAL DR STE 2B2C
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-8897
Mailing Address - Country:US
Mailing Address - Phone:207-883-3491
Mailing Address - Fax:207-885-5587
Practice Address - Street 1:300 PROFESSIONAL DR STE 2B2C
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-8897
Practice Address - Country:US
Practice Address - Phone:207-883-3491
Practice Address - Fax:207-885-5587
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC55911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME205250000Medicaid
ME001464701Medicare PIN