Provider Demographics
NPI:1841407517
Name:TRANCHEMONTAGNE, STEPHANIE ROSE (SOCIAL WORKER LSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ROSE
Last Name:TRANCHEMONTAGNE
Suffix:
Gender:F
Credentials:SOCIAL WORKER LSW
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:100 WATERMAN DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2880
Mailing Address - Country:US
Mailing Address - Phone:207-805-0191
Mailing Address - Fax:207-799-1350
Practice Address - Street 1:100 WATERMAN DR
Practice Address - Street 2:SUITE 102
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2880
Practice Address - Country:US
Practice Address - Phone:207-805-0191
Practice Address - Fax:207-799-1350
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2016-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC160231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical