| Laura Gottfried Lcsw Inc. | |
|
145 Newbury St Ste 2 Portland ME 04101-4261 | |
| (207) 773-0073 | |
| Not Available |
| Full Name | Laura Gottfried Lcsw Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 145 Newbury St Ste 2, Portland, Maine |
| Authorized Official Name and Position | Laura Gottfried (PROVIDER OWNER) |
| Authorized Official Contact | 2077730073 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Laura Gottfried Lcsw Inc. 145 Newbury St Ste 2 Portland ME 04101-4261 Ph: (207) 773-0073 | Laura Gottfried Lcsw Inc. 145 Newbury St Ste 2 Portland ME 04101-4261 Ph: (207) 773-0073 |
| NPI Number | 1851999841 |
|---|---|
| Provider Enumeration Date | 10/13/2020 |
| Last Update Date | 10/13/2020 |
| Certification Date | 10/13/2020 |
| Medicare PECOS PAC ID | 1153733225 |
|---|---|
| Medicare Enrollment ID | O20201214002143 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851999841 | NPI | - | NPPES |
| 1669584058 | Medicaid | ME |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Laura J Gottfried |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669584058 PECOS PAC ID: 8325080542 Enrollment ID: I20050527000456 |
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