Provider Demographics
NPI:1891703674
Name:YEATON, AUDREY J (LCSW)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:J
Last Name:YEATON
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 1:433 US ROUTE 1
Mailing Address - Street 2:SUITE 215
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909-1659
Mailing Address - Country:US
Mailing Address - Phone:207-337-5507
Mailing Address - Fax:207-351-1975
Practice Address - Street 1:433 US ROUTE 1
Practice Address - Street 2:SUITE 215
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-1659
Practice Address - Country:US
Practice Address - Phone:207-337-5507
Practice Address - Fax:207-351-1975
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC114721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME266440099Medicaid