Provider Demographics
NPI:1255768701
Name:GAHAGAN, AMBER (LCSW)
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:
Last Name:GAHAGAN
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 1:20 HOWLAND RD
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:ME
Mailing Address - Zip Code:04453-5321
Mailing Address - Country:US
Mailing Address - Phone:207-943-7317
Mailing Address - Fax:207-943-5314
Practice Address - Street 1:22 HOWLAND RD
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:ME
Practice Address - Zip Code:04453-5321
Practice Address - Country:US
Practice Address - Phone:207-943-7317
Practice Address - Fax:207-943-5314
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC51681041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool