Doctor Name: | COLLEEN N DWAN |
NPI Number: | 1386930360 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMSW |
License Number: | MC13131 |
Business Practice Address: | 148 E Main St Dover Foxcroft, ME - 044261305 |
Business Phone Number: | 2075643323 |
Business Fax Number: | 2075643321 |
Mailing Address: | 572 Bangor Rd, DOVER FOXCROFT |
State: | ME |
Postal Code: | 044263373 |
Phone Number: | 2075642464 |
Fax Number: | 2075642404 |
NPI Enumeration Date: | 06/28/2011 |
NPI Last Update Date: | 06/28/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | MC13131 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ME |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |