Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | LC11559 | ME |
NPI | 1003077165 |
---|---|
Provider Name | Patricia Limon Sands |
First Address | South Portland, ME 04106-2316 |
Second Address | Yarmouth, ME 04096 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2008 |
Last Update Date | 26/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
432295899 | (05) | ME |