Provider Demographics
NPI:1841589579
Name:SUTHERLAND, PERRY SAM (LCSW)
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:SAM
Last Name:SUTHERLAND
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-2110
Mailing Address - Country:US
Mailing Address - Phone:207-282-8283
Mailing Address - Fax:
Practice Address - Street 1:18 MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-2110
Practice Address - Country:US
Practice Address - Phone:207-282-8283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-04
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME13081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical