Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | MC14436 | ME |
NPI | 1003243163 |
---|---|
Provider Name | Tabitha Sagner |
First Address | Lincoln, ME 04457 |
Second Address | Bangor, ME 04401-6446 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2013 |
Last Update Date | 19/02/2015 |