Provider Demographics
NPI:1679801112
Name:ROBERTS, CARRIE LOUISE (LCSW)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:LOUISE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:LOUISE
Other - Last Name:LOCKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW-CC, CADC
Mailing Address - Street 1:50 FOREST FALLS DR STE 3
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-6937
Mailing Address - Country:US
Mailing Address - Phone:207-712-8504
Mailing Address - Fax:207-536-5937
Practice Address - Street 1:50 FOREST FALLS DR STE 3
Practice Address - Street 2:
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-6937
Practice Address - Country:US
Practice Address - Phone:207-712-8504
Practice Address - Fax:207-536-5937
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-20
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC132861041C0700X
MECAC4688101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME002713001Medicare PIN