Provider Demographics
NPI:1053887737
Name:LIFEWORKS OF MAINE LLC
Entity type:Organization
Organization Name:LIFEWORKS OF MAINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:L
Authorized Official - Last Name:MACDUFFIE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD LCSW
Authorized Official - Phone:207-307-7886
Mailing Address - Street 1:444 STILLWATER AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3500
Mailing Address - Country:US
Mailing Address - Phone:207-307-7886
Mailing Address - Fax:207-433-1241
Practice Address - Street 1:444 STILLWATER AVE STE 103
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3500
Practice Address - Country:US
Practice Address - Phone:120-307-7886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-19
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME2469600000Medicaid