Provider Demographics
NPI:1649367046
Name:CONTROVILLAS, MARY C (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:C
Last Name:CONTROVILLAS
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 1:1 LINCOLN ST
Mailing Address - Street 2:#8
Mailing Address - City:BATH
Mailing Address - State:ME
Mailing Address - Zip Code:04530-2100
Mailing Address - Country:US
Mailing Address - Phone:207-449-3591
Mailing Address - Fax:207-832-6281
Practice Address - Street 1:1 LINCOLN ST
Practice Address - Street 2:#8
Practice Address - City:BATH
Practice Address - State:ME
Practice Address - Zip Code:04530-2100
Practice Address - Country:US
Practice Address - Phone:207-449-3591
Practice Address - Fax:207-832-6281
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical