Provider Demographics
NPI:1255755799
Name:GLIDDEN, ALEXIS ARIELLE (LCSW)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:ARIELLE
Last Name:GLIDDEN
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 1:24 STONE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-5298
Mailing Address - Country:US
Mailing Address - Phone:207-213-2161
Mailing Address - Fax:
Practice Address - Street 1:2518 RTE 202
Practice Address - Street 2:
Practice Address - City:EAST WINTHROP
Practice Address - State:ME
Practice Address - Zip Code:04343
Practice Address - Country:US
Practice Address - Phone:207-213-2168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-04
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC159681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical