Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | LC7778 | ME |
NPI | 1003103599 |
---|---|
Provider Name | Ms. Beverly Rae Dow |
First Address | Sanford, ME 04073-4210 |
Second Address | Sanford, ME 04073-4210 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2011 |
Last Update Date | 05/07/2011 |