Provider Demographics
NPI:1952638785
Name:SERRA, MARIA RUTH (LCSW)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:RUTH
Last Name:SERRA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MARIA
Other - Middle Name:R
Other - Last Name:SERRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:68 TUTTLE DR
Mailing Address - Street 2:
Mailing Address - City:HARPSWELL
Mailing Address - State:ME
Mailing Address - Zip Code:04079-3948
Mailing Address - Country:US
Mailing Address - Phone:207-833-5986
Mailing Address - Fax:
Practice Address - Street 1:68 TUTTLE DR
Practice Address - Street 2:
Practice Address - City:HARPSWELL
Practice Address - State:ME
Practice Address - Zip Code:04079-3948
Practice Address - Country:US
Practice Address - Phone:207-833-5986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-16
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC2611101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME2411OtherMAINECARE