Provider Demographics
NPI:1790931178
Name:AYOOB, ALICE ELIZABETH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ALICE
Middle Name:ELIZABETH
Last Name:AYOOB
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 1:3 FUNDY RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1775
Mailing Address - Country:US
Mailing Address - Phone:207-650-9076
Mailing Address - Fax:
Practice Address - Street 1:3 FUNDY RD
Practice Address - Street 2:STE 2
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1775
Practice Address - Country:US
Practice Address - Phone:207-650-9076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC126871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME001802901Medicare PIN