Provider Demographics
NPI:1134229917
Name:HOUSE, PRISCILLA R (LCSW)
Entity type:Individual
Prefix:MS
First Name:PRISCILLA
Middle Name:R
Last Name:HOUSE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:ME
Mailing Address - Zip Code:04553
Mailing Address - Country:US
Mailing Address - Phone:207-563-8522
Mailing Address - Fax:207-563-8522
Practice Address - Street 1:15 BELVEDERE ROAD
Practice Address - Street 2:
Practice Address - City:DAMARISCOTTA
Practice Address - State:ME
Practice Address - Zip Code:04543-4614
Practice Address - Country:US
Practice Address - Phone:207-563-8522
Practice Address - Fax:207-563-8522
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC54741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical