Provider Demographics
NPI:1932274859
Name:HANLON, MARIETTE MARIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARIETTE
Middle Name:MARIE
Last Name:HANLON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:MARIETTE
Other - Middle Name:MARIE
Other - Last Name:ST PIERRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16 FARWELL STREET
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:ME
Mailing Address - Zip Code:04250
Mailing Address - Country:US
Mailing Address - Phone:207-353-8118
Mailing Address - Fax:
Practice Address - Street 1:16 FARWELL STREET
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:ME
Practice Address - Zip Code:04250
Practice Address - Country:US
Practice Address - Phone:207-353-8118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEME157503104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker