Provider Demographics
NPI:1396100541
Name:AUDET, CHRISTINE M (LCSW)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:AUDET
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 1:9 JANS BLVD
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-1642
Mailing Address - Country:US
Mailing Address - Phone:207-240-2239
Mailing Address - Fax:207-782-9001
Practice Address - Street 1:95 PARK ST STE 201
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7282
Practice Address - Country:US
Practice Address - Phone:207-240-2239
Practice Address - Fax:207-782-9001
Is Sole Proprietor?:No
Enumeration Date:2015-12-15
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC5208172V00000X
MELC201281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MECAC5208OtherCADC