Provider Demographics
NPI:1063255883
Name:LADERER, AVERY STOWE (LCPC-C)
Entity type:Individual
Prefix:
First Name:AVERY
Middle Name:STOWE
Last Name:LADERER
Suffix:
Gender:F
Credentials:LCPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 FULLERTON ST
Mailing Address - Street 2:
Mailing Address - City:BOOTHBAY HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04538-1886
Mailing Address - Country:US
Mailing Address - Phone:207-350-5356
Mailing Address - Fax:
Practice Address - Street 1:9 FIELD ST STE 219
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-6643
Practice Address - Country:US
Practice Address - Phone:207-505-6082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL7562101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor