Provider Demographics
NPI:1790098960
Name:BOOTHBY, MEGAN C (LCSW)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:C
Last Name:BOOTHBY
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 1:222 SAINT JOHN ST STE 213
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3063
Mailing Address - Country:US
Mailing Address - Phone:207-370-1238
Mailing Address - Fax:207-842-7773
Practice Address - Street 1:222 SAINT JOHN ST STE 213
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3063
Practice Address - Country:US
Practice Address - Phone:207-370-1238
Practice Address - Fax:207-835-0009
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC139351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME436317199Medicaid
ME003125301Medicare PIN