Provider Demographics
NPI:1285089193
Name:WINSLOW, SUSAN J (LADC, RN)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:WINSLOW
Suffix:
Gender:F
Credentials:LADC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 SHEPHERD LN
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-1673
Mailing Address - Country:US
Mailing Address - Phone:207-749-4866
Mailing Address - Fax:
Practice Address - Street 1:3 FUNDY RD
Practice Address - Street 2:SUITE 2
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1775
Practice Address - Country:US
Practice Address - Phone:207-749-4866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC4991101YA0400X
MERN38403163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No163W00000XNursing Service ProvidersRegistered Nurse