Provider Demographics
NPI:1821875105
Name:SANBORN, ELISABETH (CADC)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:
Last Name:SANBORN
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 CONGRESS ST STE 416
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-5355
Mailing Address - Country:US
Mailing Address - Phone:207-780-8999
Mailing Address - Fax:207-615-0018
Practice Address - Street 1:615 CONGRESS ST STE 416
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-5355
Practice Address - Country:US
Practice Address - Phone:207-780-8999
Practice Address - Fax:207-615-0018
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC8576101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)