Provider Demographics
NPI:1891208005
Name:MARCOTTE, AMY LOUISE (LCSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LOUISE
Last Name:MARCOTTE
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 1:628 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGVALE
Mailing Address - State:ME
Mailing Address - Zip Code:04083-1728
Mailing Address - Country:US
Mailing Address - Phone:207-490-1513
Mailing Address - Fax:207-490-1609
Practice Address - Street 1:628 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGVALE
Practice Address - State:ME
Practice Address - Zip Code:04083-1728
Practice Address - Country:US
Practice Address - Phone:207-490-1513
Practice Address - Fax:207-490-1609
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC75911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical