Provider Demographics
NPI:1295895340
Name:FRICKE, MARIANNE (LCSW)
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:FRICKE
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 1:268 STATE ST
Mailing Address - Street 2:ROOM 2-4
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5417
Mailing Address - Country:US
Mailing Address - Phone:207-990-0188
Mailing Address - Fax:207-990-6604
Practice Address - Street 1:268 STATE ST
Practice Address - Street 2:ROOM 2-4
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5417
Practice Address - Country:US
Practice Address - Phone:207-990-0188
Practice Address - Fax:207-990-6604
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC7263104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME291250099Medicaid
ME332129OtherTRI-CARE
ME7286556OtherAETNA
ME100017OtherANTHEM
ME332129OtherTRI-CARE