Provider Demographics
NPI:1790477016
Name:LAKIS, PETER VALDIS (LMSW-CC)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:VALDIS
Last Name:LAKIS
Suffix:
Gender:M
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 ISLAND VIEW LN
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-3550
Mailing Address - Country:US
Mailing Address - Phone:207-350-5898
Mailing Address - Fax:
Practice Address - Street 1:66 BARIBEAU DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-3230
Practice Address - Country:US
Practice Address - Phone:207-373-6950
Practice Address - Fax:207-373-6959
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC21933104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker