Provider Demographics
NPI:1679503734
Name:LANDER, ELIZABETH H (LCSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:H
Last Name:LANDER
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 1:45 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:ORRINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04474-3039
Mailing Address - Country:US
Mailing Address - Phone:207-992-7070
Mailing Address - Fax:207-989-3709
Practice Address - Street 1:141 N MAIN ST
Practice Address - Street 2:SUITE 303
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-2011
Practice Address - Country:US
Practice Address - Phone:207-992-7070
Practice Address - Fax:207-989-3709
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC 44341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME205360000Medicaid
ME027754OtherANTHEM ID NUMBER
ME20042997DCOtherLLC ID NUMBER