Provider Demographics
NPI:1134352164
Name:LAMOREAU, RAE
Entity type:Individual
Prefix:
First Name:RAE
Middle Name:
Last Name:LAMOREAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 43
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:ME
Mailing Address - Zip Code:04740-0043
Mailing Address - Country:US
Mailing Address - Phone:207-488-0975
Mailing Address - Fax:207-488-0975
Practice Address - Street 1:44 STATION RD
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:ME
Practice Address - Zip Code:04740-0043
Practice Address - Country:US
Practice Address - Phone:207-488-0975
Practice Address - Fax:207-488-0975
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME434467000Medicaid