Provider Demographics
NPI:1841534005
Name:BLANCHARD, LOLITA DOROTHY (MSW-CC)
Entity type:Individual
Prefix:
First Name:LOLITA
Middle Name:DOROTHY
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:MSW-CC
Other - Prefix:
Other - First Name:LITA
Other - Middle Name:DOROTHY
Other - Last Name:BLANCHARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW-CC
Mailing Address - Street 1:511 WINTHROP CENTER RD
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:ME
Mailing Address - Zip Code:04364-3547
Mailing Address - Country:US
Mailing Address - Phone:207-395-8001
Mailing Address - Fax:
Practice Address - Street 1:511 WINTHROP CENTER RD
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:ME
Practice Address - Zip Code:04364-3547
Practice Address - Country:US
Practice Address - Phone:207-395-8001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-12
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC129031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical