Provider Demographics
NPI:1760532402
Name:AVANT, EARL S JR (LCSW)
Entity Type:Individual
Prefix:
First Name:EARL
Middle Name:S
Last Name:AVANT
Suffix:JR
Gender:M
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 WINTERVIEW RD
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032-6210
Mailing Address - Country:US
Mailing Address - Phone:207-865-9131
Mailing Address - Fax:207-865-9185
Practice Address - Street 1:2 WINTERVIEW RD
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:ME
Practice Address - Zip Code:04032-6210
Practice Address - Country:US
Practice Address - Phone:207-865-9131
Practice Address - Fax:207-865-9185
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical