Provider Demographics
NPI:1780949800
Name:ELLIOTT, AMBER R (LCSW)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:R
Last Name:ELLIOTT
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:PO BOX 1565
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-1565
Mailing Address - Country:US
Mailing Address - Phone:207-590-9207
Mailing Address - Fax:207-282-5230
Practice Address - Street 1:227 CONGRESS ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-3609
Practice Address - Country:US
Practice Address - Phone:207-590-9207
Practice Address - Fax:207-282-5230
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC129881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical