Provider Demographics
NPI:1962819953
Name:OSTROW, EMILY SHAYNA (LCSW)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:SHAYNA
Last Name:OSTROW
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:469 MAIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SPRINGVALE
Mailing Address - State:ME
Mailing Address - Zip Code:04083-1870
Mailing Address - Country:US
Mailing Address - Phone:207-490-6600
Mailing Address - Fax:207-490-6603
Practice Address - Street 1:469 MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SPRINGVALE
Practice Address - State:ME
Practice Address - Zip Code:04083-1870
Practice Address - Country:US
Practice Address - Phone:207-490-6600
Practice Address - Fax:207-490-6603
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC147641041C0700X
MA1166641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical