Provider Demographics
NPI:1720146103
Name:WISCH, HADASSA B (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:HADASSA
Middle Name:B
Last Name:WISCH
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04841-2602
Mailing Address - Country:US
Mailing Address - Phone:207-594-4484
Mailing Address - Fax:
Practice Address - Street 1:32 SCHOOL STREET
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841-2602
Practice Address - Country:US
Practice Address - Phone:207-596-0955
Practice Address - Fax:207-596-0956
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC90401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME035286OtherANTHEM BCBS
MEWI-ME0418Medicare ID - Type UnspecifiedMEDICARE