Provider Demographics
NPI:1952855629
Name:LAURIE SIVONEN LCSW LLC
Entity Type:Organization
Organization Name:LAURIE SIVONEN LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIVONEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:207-221-6644
Mailing Address - Street 1:6 SOKOKIS CIR
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-1874
Mailing Address - Country:US
Mailing Address - Phone:207-221-6644
Mailing Address - Fax:207-510-8021
Practice Address - Street 1:4 SCAMMON ST STE 19-399
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-5121
Practice Address - Country:US
Practice Address - Phone:207-221-6644
Practice Address - Fax:207-510-8021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-10
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC119931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty