Provider Demographics
NPI:1285174656
Name:LARIVIERE, MARTHA DIANE (MA, LMFT-C)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:DIANE
Last Name:LARIVIERE
Suffix:
Gender:F
Credentials:MA, LMFT-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 DEAN DR
Mailing Address - Street 2:
Mailing Address - City:NORTH WATERBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04061-4300
Mailing Address - Country:US
Mailing Address - Phone:207-315-9939
Mailing Address - Fax:
Practice Address - Street 1:25 DEAN DR
Practice Address - Street 2:
Practice Address - City:NORTH WATERBORO
Practice Address - State:ME
Practice Address - Zip Code:04061-4300
Practice Address - Country:US
Practice Address - Phone:207-315-9939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-03
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXM4738106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist