Provider Demographics
NPI:1801105721
Name:FOURRE, ANN (LCSW)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:FOURRE
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 1:510 CUMBERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2220
Mailing Address - Country:US
Mailing Address - Phone:207-553-5800
Mailing Address - Fax:207-874-1155
Practice Address - Street 1:510 CUMBERLAND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2220
Practice Address - Country:US
Practice Address - Phone:207-553-5800
Practice Address - Fax:207-874-1155
Is Sole Proprietor?:No
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC57331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical