Provider Demographics
NPI:1124456066
Name:HAMPLE, LAUREN S B (LCSW)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:S B
Last Name:HAMPLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:S
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:149 NORTH STREET
Mailing Address - Street 2:3200
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-6789
Mailing Address - Country:US
Mailing Address - Phone:207-861-3500
Mailing Address - Fax:207-861-6201
Practice Address - Street 1:149 NORTH STREET
Practice Address - Street 2:3200
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-6789
Practice Address - Country:US
Practice Address - Phone:207-861-3500
Practice Address - Fax:207-861-6201
Is Sole Proprietor?:No
Enumeration Date:2013-10-30
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC166351041C0700X
MEMC16780101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1760596480Medicaid
ME1124456066Medicaid