Provider Demographics
NPI:1669080636
Name:WOOSTER, LORA (LSW, MHRT/C)
Entity type:Individual
Prefix:
First Name:LORA
Middle Name:
Last Name:WOOSTER
Suffix:
Gender:F
Credentials:LSW, MHRT/C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 MAIN ST STE 205
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-2432
Mailing Address - Country:US
Mailing Address - Phone:207-602-0473
Mailing Address - Fax:207-494-8471
Practice Address - Street 1:281 MAIN ST
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-2412
Practice Address - Country:US
Practice Address - Phone:207-494-8010
Practice Address - Fax:207-494-8471
Is Sole Proprietor?:No
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA314271104100000X
MELS18749104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker