Provider Demographics
NPI:1104965466
Name:CONRAD, EMILEE T (LCSW)
Entity type:Individual
Prefix:
First Name:EMILEE
Middle Name:T
Last Name:CONRAD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:EMILEE
Other - Middle Name:J
Other - Last Name:TRAFTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3 FUNDY RD STE 2
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1796
Mailing Address - Country:US
Mailing Address - Phone:207-200-1477
Mailing Address - Fax:
Practice Address - Street 1:3 FUNDY RD
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1775
Practice Address - Country:US
Practice Address - Phone:207-200-1477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0063101041C0700X
MELC183201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSW1346Medicaid
NC1104965466Medicaid
NCQ53223AMedicare PIN