Provider Demographics
NPI:1932470333
Name:TIMBERLAKE-TIBBETTS, SANDY (LCSW-CC)
Entity Type:Individual
Prefix:
First Name:SANDY
Middle Name:
Last Name:TIMBERLAKE-TIBBETTS
Suffix:
Gender:F
Credentials:LCSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 MAINE ST
Mailing Address - Street 2:SUITE 412, BOX 49
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2049
Mailing Address - Country:US
Mailing Address - Phone:207-798-3922
Mailing Address - Fax:207-798-3944
Practice Address - Street 1:14 MAINE ST
Practice Address - Street 2:SUITE 412, BOX 49
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2049
Practice Address - Country:US
Practice Address - Phone:207-798-3922
Practice Address - Fax:207-798-3944
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC133871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical