Provider Demographics
NPI:1205048345
Name:ABBOTT, MARINA ANN (LCSW)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:ANN
Last Name:ABBOTT
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:PO BOX 417
Mailing Address - Street 2:NFI NORTH
Mailing Address - City:CONTOOCOOK
Mailing Address - State:NH
Mailing Address - Zip Code:03229
Mailing Address - Country:US
Mailing Address - Phone:207-299-1935
Mailing Address - Fax:
Practice Address - Street 1:160 LAPOINT ROAD
Practice Address - Street 2:STETSON RANCH-
Practice Address - City:STETSON
Practice Address - State:ME
Practice Address - Zip Code:04488
Practice Address - Country:US
Practice Address - Phone:207-296-2487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME#MC109581041C0700X
MELC137441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical