Provider Demographics
NPI:1871668624
Name:SIMPSON, AMY L (LCSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:SIMPSON
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 1:23 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-5740
Mailing Address - Country:US
Mailing Address - Phone:207-470-0573
Mailing Address - Fax:207-591-9176
Practice Address - Street 1:23 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-5740
Practice Address - Country:US
Practice Address - Phone:207-470-0573
Practice Address - Fax:207-591-9176
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC117081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical