Provider Demographics
NPI:1922430560
Name:SANFILIPPO, FRANK (LCSW)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:
Last Name:SANFILIPPO
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 1:96 DOUGLASS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2525
Mailing Address - Country:US
Mailing Address - Phone:207-221-8636
Mailing Address - Fax:207-874-2371
Practice Address - Street 1:50 MONUMENT SQ
Practice Address - Street 2:4TH FLOOR
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-4039
Practice Address - Country:US
Practice Address - Phone:207-221-8636
Practice Address - Fax:207-874-2371
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC141681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical