Provider Demographics
NPI:1821004417
Name:CRIMP-MARCET, SUSAN E (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:CRIMP-MARCET
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 1:78 ATLANTIC PL
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2316
Mailing Address - Country:US
Mailing Address - Phone:207-842-7701
Mailing Address - Fax:207-842-7773
Practice Address - Street 1:35 CENTER ST
Practice Address - Street 2:
Practice Address - City:WOLFEBORO
Practice Address - State:NH
Practice Address - Zip Code:03894
Practice Address - Country:US
Practice Address - Phone:207-939-9458
Practice Address - Fax:603-515-1700
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC36701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME307930099Medicaid
ME307930099Medicaid
MEUX4513Medicare PIN