Provider Demographics
NPI:1336372077
Name:MONIQUE ANNE SPINA LCSW
Entity Type:Organization
Organization Name:MONIQUE ANNE SPINA LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:SPINA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:207-468-7236
Mailing Address - Street 1:PO BOX 623
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-0623
Mailing Address - Country:US
Mailing Address - Phone:207-468-7236
Mailing Address - Fax:
Practice Address - Street 1:2 MAIN ST
Practice Address - Street 2:SUITE 17-302
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-2631
Practice Address - Country:US
Practice Address - Phone:207-468-7236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-28
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC81531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME272050099Medicaid