Provider Demographics
NPI:1154341139
Name:DAIGLE, DEBORAH L (LCSW)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:DAIGLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:L
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:69 DOCKSIDE LN
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-6090
Mailing Address - Country:US
Mailing Address - Phone:207-436-1630
Mailing Address - Fax:
Practice Address - Street 1:7 SCHOOL ST
Practice Address - Street 2:SUITE 1
Practice Address - City:ALBION
Practice Address - State:ME
Practice Address - Zip Code:04910-6501
Practice Address - Country:US
Practice Address - Phone:207-437-9388
Practice Address - Fax:207-437-2557
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC116411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MELC11641OtherSTATE OF MAINE, LICENSED CLINICAL SOCIAL WORKER