Provider Demographics
NPI:1720096464
Name:MAHER, MARILYN (LCSW; LACD)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:
Last Name:MAHER
Suffix:
Gender:F
Credentials:LCSW; LACD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2130
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04241-2130
Mailing Address - Country:US
Mailing Address - Phone:207-783-2800
Mailing Address - Fax:
Practice Address - Street 1:27 MAPLEWOOD RD
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-1626
Practice Address - Country:US
Practice Address - Phone:207-783-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC2645101YA0400X
MELC63811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)