Provider Demographics
NPI:1942773536
Name:PAGE, BRITTANY (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:PAGE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:
Other - Last Name:SHRACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:401 CUMBERLAND AVE APT 601
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2873
Mailing Address - Country:US
Mailing Address - Phone:317-270-0007
Mailing Address - Fax:
Practice Address - Street 1:401 CUMBERLAND AVE APT 601
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2873
Practice Address - Country:US
Practice Address - Phone:317-270-0007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC178201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical