Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ME317297 | ME |
Y | 1041C0700X | Clinical Social Worker | ME324956 | ME |
NPI | 1003037912 |
---|---|
Provider Name | Maria A Moustrouphis |
First Address | Portland, ME 04103-3922 |
Second Address | Portland, ME 04103-3922 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 05/11/2021 |