Provider Demographics
NPI:1801083621
Name:SUNDERLAND, SUMMER (LCSW)
Entity type:Individual
Prefix:MS
First Name:SUMMER
Middle Name:
Last Name:SUNDERLAND
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 1:97 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:ORONO
Mailing Address - State:ME
Mailing Address - Zip Code:04473-3653
Mailing Address - Country:US
Mailing Address - Phone:207-355-5777
Mailing Address - Fax:888-845-9306
Practice Address - Street 1:97 FOREST AVE
Practice Address - Street 2:
Practice Address - City:ORONO
Practice Address - State:ME
Practice Address - Zip Code:04473-3653
Practice Address - Country:US
Practice Address - Phone:207-355-5777
Practice Address - Fax:888-845-9306
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC99461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical