Provider Demographics
NPI:1073822631
Name:LABRECQUE, LOUISE M
Entity type:Individual
Prefix:
First Name:LOUISE
Middle Name:M
Last Name:LABRECQUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 649
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073-0649
Mailing Address - Country:US
Mailing Address - Phone:207-793-8103
Mailing Address - Fax:207-793-2408
Practice Address - Street 1:97 DEMERITT ROAD
Practice Address - Street 2:
Practice Address - City:WEST NEWFIELD
Practice Address - State:ME
Practice Address - Zip Code:04095
Practice Address - Country:US
Practice Address - Phone:207-793-8103
Practice Address - Fax:207-793-2408
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME6656071253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency