Provider Demographics
NPI:1215994090
Name:PONTTI, STEPHANIE H (LCPC)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:H
Last Name:PONTTI
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MRS
Other - First Name:STEPHANIE
Other - Middle Name:H
Other - Last Name:CIMMET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:4 COTTAGE STREET
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032
Mailing Address - Country:US
Mailing Address - Phone:207-504-2664
Mailing Address - Fax:207-865-2004
Practice Address - Street 1:4 COTTAGE STREET
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:ME
Practice Address - Zip Code:04032
Practice Address - Country:US
Practice Address - Phone:207-504-2664
Practice Address - Fax:207-865-2004
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC2454101Y00000X
CC2454101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431549499Medicaid