Provider Demographics
NPI:1013272855
Name:STUBBS, TRISHA M (LCSW)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:M
Last Name:STUBBS
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 1:45 HILLSIDE ST
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-2620
Mailing Address - Country:US
Mailing Address - Phone:207-768-0368
Mailing Address - Fax:207-764-1649
Practice Address - Street 1:45 HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-2620
Practice Address - Country:US
Practice Address - Phone:207-768-0368
Practice Address - Fax:207-764-1649
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC154211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1013272855Medicaid