Provider Demographics
NPI:1760544522
Name:BRAGA, MARGARET DEROSE (LCPC, LSW)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:DEROSE
Last Name:BRAGA
Suffix:
Gender:F
Credentials:LCPC, LSW
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:ELIZABETH
Other - Last Name:DEROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:190 RIVERSIDE ST UNIT 6B
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-1073
Mailing Address - Country:US
Mailing Address - Phone:207-661-2000
Mailing Address - Fax:207-661-2033
Practice Address - Street 1:254 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2410
Practice Address - Country:US
Practice Address - Phone:207-661-0440
Practice Address - Fax:207-661-0444
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELS4051104100000X
MECC1208101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker