Provider Demographics
NPI:1740405554
Name:BLANCHETTE, ELIZABETH SUE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:SUE
Last Name:BLANCHETTE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 787
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-0787
Mailing Address - Country:US
Mailing Address - Phone:207-667-0909
Mailing Address - Fax:207-667-6348
Practice Address - Street 1:324 GANNETT DRIVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106
Practice Address - Country:US
Practice Address - Phone:207-771-5700
Practice Address - Fax:207-771-5750
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC6734104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431973399Medicaid