Provider Demographics
NPI:1710991096
Name:BERUBE, MARIANNE CAYES (LCSW)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:CAYES
Last Name:BERUBE
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 1:58 PORTLAND RD
Mailing Address - Street 2:P.O. BOX 1084
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-6656
Mailing Address - Country:US
Mailing Address - Phone:207-432-2296
Mailing Address - Fax:207-799-9353
Practice Address - Street 1:58 PORTLAND RD
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-6656
Practice Address - Country:US
Practice Address - Phone:207-432-2296
Practice Address - Fax:207-799-9353
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2015-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC114671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432258899Medicaid
ME432258899Medicaid
MEE400169950Medicare PIN