Basic Information
| Provider Information | |||||||||
| NPI: | 1730370495 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DELORIE | ||||||||
| FirstName: | SAMANTHA | ||||||||
| MiddleName: | JEAN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSW-CC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 COMMERCE DR | ||||||||
| Address2: | |||||||||
| City: | SKOWHEGAN | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049764823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074748311 | ||||||||
| FaxNumber: | 2074745148 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 COMMERCE DR | ||||||||
| Address2: | |||||||||
| City: | SKOWHEGAN | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049764823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074748311 | ||||||||
| FaxNumber: | 2074745148 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2007 | ||||||||
| LastUpdateDate: | 08/07/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | MC11143 | ME | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.