Provider Demographics
NPI:1134224413
Name:LORD, LOUISE MACCUBREY (LCSW)
Entity type:Individual
Prefix:
First Name:LOUISE
Middle Name:MACCUBREY
Last Name:LORD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LOUISE
Other - Middle Name:MACCUBREY
Other - Last Name:ROBBINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4 WELLSPRING RD
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005
Mailing Address - Country:US
Mailing Address - Phone:207-282-6309
Mailing Address - Fax:207-282-9920
Practice Address - Street 1:4 WELLSPRING RD
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005
Practice Address - Country:US
Practice Address - Phone:207-282-6309
Practice Address - Fax:207-282-9920
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC12671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
5479264OtherAETNA
1039302OtherCIGNA
007304OtherANTHEM
1039302OtherCIGNA