Provider Demographics
NPI:1063527257
Name:DESCHAINE, LORI ANN (LCSW)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:DESCHAINE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:ANN
Other - Last Name:KILCOLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW-LCSW
Mailing Address - Street 1:180 ACADEMY ST STE 3
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-3183
Mailing Address - Country:US
Mailing Address - Phone:207-554-2352
Mailing Address - Fax:207-554-2351
Practice Address - Street 1:23 HIGH ST
Practice Address - Street 2:
Practice Address - City:FORT FAIRFIELD
Practice Address - State:ME
Practice Address - Zip Code:04742-1021
Practice Address - Country:US
Practice Address - Phone:207-472-6134
Practice Address - Fax:207-472-6153
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC106631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME415010099Medicaid