Provider Demographics
NPI:1952317943
Name:MADIGAN, COLLEEN MAIREAD (LCSW)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:MAIREAD
Last Name:MADIGAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:MAIREAD
Other - Last Name:MADIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:66 STONE ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-5227
Mailing Address - Country:US
Mailing Address - Phone:207-626-3455
Mailing Address - Fax:207-626-3612
Practice Address - Street 1:66 STONE ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5227
Practice Address - Country:US
Practice Address - Phone:207-626-3455
Practice Address - Fax:207-626-3612
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC73141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME304230099Medicaid