Provider Demographics
NPI:1386402766
Name:NELLIGAN, ANNETTE FRANCES
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:FRANCES
Last Name:NELLIGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 ALBERT LN
Mailing Address - Street 2:
Mailing Address - City:GLENBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04401-1025
Mailing Address - Country:US
Mailing Address - Phone:207-944-8266
Mailing Address - Fax:
Practice Address - Street 1:24 ALBERT LN
Practice Address - Street 2:
Practice Address - City:GLENBURN
Practice Address - State:ME
Practice Address - Zip Code:04401-1025
Practice Address - Country:US
Practice Address - Phone:207-944-8266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMF999101YP2500X
MECC998101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional