Provider Demographics
NPI:1730414871
Name:GIRARD, PRISCILLA (LCSW)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:GIRARD
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 1:155 SILVER ST STE 3
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-5851
Mailing Address - Country:US
Mailing Address - Phone:207-877-5011
Mailing Address - Fax:
Practice Address - Street 1:155 SILVER STREET
Practice Address - Street 2:SUITE #3
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901
Practice Address - Country:US
Practice Address - Phone:207-877-5011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-07
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC132401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical