Provider Demographics
NPI:1801033485
Name:LORING, DANIELLE M (LCSW)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:M
Last Name:LORING
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:M
Other - Last Name:MANSOLILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 SOUTHBOROUGH DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-6914
Mailing Address - Country:US
Mailing Address - Phone:207-661-2018
Mailing Address - Fax:207-661-2033
Practice Address - Street 1:2 SPRINGBROOK DR
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9443
Practice Address - Country:US
Practice Address - Phone:207-282-1500
Practice Address - Fax:207-282-2581
Is Sole Proprietor?:No
Enumeration Date:2009-01-19
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC163371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME433379299Medicaid
MEE400365033Medicare PIN