Basic Information
| Provider Information | |||||||||
| NPI: | 1811058845 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAWTON | ||||||||
| FirstName: | DIANE | ||||||||
| MiddleName: | S. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 216 VAUGHAN ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041023204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076622221 | ||||||||
| FaxNumber: | 2076626348 | ||||||||
| Practice Location | |||||||||
| Address1: | 216 VAUGHAN ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041023204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076622221 | ||||||||
| FaxNumber: | 2076626348 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LC7923 | ME | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.