Basic Information
Provider Information
NPI: 1003001272
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: OCHOA-DURRELL
FirstName: DEANNE
MiddleName: E
NamePrefix: MRS.
NameSuffix:  
Credential: LCSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 24 WHEELER ST
Address2:  
City: LIVERMORE FALLS
State: ME
PostalCode: 042541231
CountryCode: US
TelephoneNumber: 2078972061
FaxNumber:  
Practice Location
Address1: 125 FRANKLIN ST
Address2:  
City: RUMFORD
State: ME
PostalCode: 042762201
CountryCode: US
TelephoneNumber: 2079645257
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/11/2007
LastUpdateDate: 09/11/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700XLC11217MEY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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