Provider Demographics
NPI:1265528392
Name:HASHAM, AMIE LYN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:AMIE
Middle Name:LYN
Last Name:HASHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AMIE
Other - Middle Name:LYN
Other - Last Name:QUIRION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCS
Mailing Address - Street 1:52 CHRISTIAN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-2116
Mailing Address - Country:US
Mailing Address - Phone:207-667-5357
Mailing Address - Fax:207-288-7024
Practice Address - Street 1:52 CHRISTIAN RIDGE RD
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-2116
Practice Address - Country:US
Practice Address - Phone:207-667-5357
Practice Address - Fax:207-288-7024
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC107091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MELC10709OtherMAINE LICENSE
ME411810099Medicaid
MELC10709OtherMAINE LICENSE
MEOTH000Medicare UPIN