Provider Demographics
NPI:1730279852
Name:WIGHT, LORRAINE O (LCSW)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:O
Last Name:WIGHT
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 1:2 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:ME
Mailing Address - Zip Code:04250-6245
Mailing Address - Country:US
Mailing Address - Phone:207-440-3248
Mailing Address - Fax:
Practice Address - Street 1:178 LISBON ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7234
Practice Address - Country:US
Practice Address - Phone:207-440-3284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC83171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME261000099Medicaid
MERB9OtherANTHEM