Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | LC15393 | ME |
N | 1041C0700X | Clinical Social Worker | MC14221 | ME |
NPI | 1003257825 |
---|---|
Provider Name | Mark Thurlow |
First Address | Winn, ME 04495-5329 |
Second Address | Winn, ME 04495-5329 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2013 |
Last Update Date | 08/02/2016 |