Basic Information
Provider Information
NPI: 1699102228
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RADMORE-SPEAR
FirstName: ALYSSA
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: LCSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 67 EUSTIS PKWY
Address2:  
City: WATERVILLE
State: ME
PostalCode: 049015173
CountryCode: US
TelephoneNumber: 2078732136
FaxNumber: 2076604529
Practice Location
Address1: 67 EUSTIS PKWY
Address2:  
City: WATERVILLE
State: ME
PostalCode: 049015173
CountryCode: US
TelephoneNumber: 2078732136
FaxNumber: 2076604529
Other Information
ProviderEnumerationDate: 09/27/2013
LastUpdateDate: 12/06/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700XLC16347MEY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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