Provider Demographics
NPI:1215641212
Name:SARGENT, LUCINDA JEAN (ADMINISTRATOR)
Entity type:Individual
Prefix:MRS
First Name:LUCINDA
Middle Name:JEAN
Last Name:SARGENT
Suffix:
Gender:F
Credentials:ADMINISTRATOR
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 194
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:ME
Mailing Address - Zip Code:04640-0194
Mailing Address - Country:US
Mailing Address - Phone:207-422-9112
Mailing Address - Fax:
Practice Address - Street 1:808 US HWY 1
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:ME
Practice Address - Zip Code:04640-3418
Practice Address - Country:US
Practice Address - Phone:207-422-9112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities