Provider Demographics
NPI:1053567867
Name:SIVONEN, LAURIE (LCSW)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:SIVONEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SOKOKIS CIR
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-1874
Mailing Address - Country:US
Mailing Address - Phone:207-221-6644
Mailing Address - Fax:207-510-8021
Practice Address - Street 1:4 SCAMMON ST STE 19-399
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-5121
Practice Address - Country:US
Practice Address - Phone:207-221-6644
Practice Address - Fax:207-510-8021
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC119931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432872299Medicaid