Provider Demographics
NPI:1700094141
Name:PAGE, MAUREEN (MS, LCPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:
Last Name:PAGE
Suffix:
Gender:F
Credentials:MS, LCPC, NCC
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:
Other - Last Name:PAGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, LCPC, NCC
Mailing Address - Street 1:5 DEL RIO DR
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-7440
Mailing Address - Country:US
Mailing Address - Phone:207-985-0804
Mailing Address - Fax:207-985-7453
Practice Address - Street 1:19 MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-7096
Practice Address - Country:US
Practice Address - Phone:207-985-0804
Practice Address - Fax:207-985-7453
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC2231101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional