Provider Demographics
NPI:1952611881
Name:CAMOLLI, SARA DAWN (LADC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:DAWN
Last Name:CAMOLLI
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:DAWN
Other - Last Name:CAMOLLI-BRABAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:95 PARK ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7282
Mailing Address - Country:US
Mailing Address - Phone:207-344-7271
Mailing Address - Fax:
Practice Address - Street 1:95 PARK ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7282
Practice Address - Country:US
Practice Address - Phone:207-344-7271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-13
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC5197101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)