Provider Demographics
NPI:1790993236
Name:DETEL, JOAN L (RN, LMSW)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:L
Last Name:DETEL
Suffix:
Gender:F
Credentials:RN, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 LISBON ST
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:ME
Mailing Address - Zip Code:04250-6866
Mailing Address - Country:US
Mailing Address - Phone:207-353-4100
Mailing Address - Fax:
Practice Address - Street 1:244 LISBON ST
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:ME
Practice Address - Zip Code:04250-6866
Practice Address - Country:US
Practice Address - Phone:207-353-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELM42911041C0700X
MERO31594163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered163W00000XNursing Service ProvidersRegistered Nurse