Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CAC3562 | ME |
NPI | 1003240508 |
---|---|
Provider Name | Jane E Delmonaco |
First Address | Calais, ME 04619 |
Second Address | Calais, ME 04619-1203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2013 |
Last Update Date | 03/09/2013 |