Provider Demographics
NPI:1952907115
Name:MACOMBER, TRINITY NICOLE (LCSW)
Entity Type:Individual
Prefix:
First Name:TRINITY
Middle Name:NICOLE
Last Name:MACOMBER
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:PO BOX 971
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:ME
Mailing Address - Zip Code:04250-0971
Mailing Address - Country:US
Mailing Address - Phone:207-252-9303
Mailing Address - Fax:
Practice Address - Street 1:8 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:LISBON FALLS
Practice Address - State:ME
Practice Address - Zip Code:04252-1612
Practice Address - Country:US
Practice Address - Phone:207-252-9303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-11
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC21797101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMC18996Medicaid