Provider Demographics
NPI:1811041619
Name:WIDMER, MARY PAULA (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY PAULA
Middle Name:
Last Name:WIDMER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:M. PAULA
Other - Middle Name:
Other - Last Name:WIDMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 711
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:ME
Mailing Address - Zip Code:04294-0711
Mailing Address - Country:US
Mailing Address - Phone:207-645-9897
Mailing Address - Fax:207-645-9897
Practice Address - Street 1:6 WIKEN LN.
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:ME
Practice Address - Zip Code:04294
Practice Address - Country:US
Practice Address - Phone:207-645-9897
Practice Address - Fax:207-645-9897
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC53621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM9069Medicare ID - Type Unspecified