Provider Demographics
NPI:1184693756
Name:FOLEY, MIA LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:LYNN
Last Name:FOLEY
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 1:908 MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073-3586
Mailing Address - Country:US
Mailing Address - Phone:603-241-8118
Mailing Address - Fax:
Practice Address - Street 1:908 MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-3586
Practice Address - Country:US
Practice Address - Phone:603-241-8118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC150541041C0700X
MA1162251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431900099Medicaid