Provider Demographics
NPI:1386710101
Name:ZEGEL, LAURA MOORE (MSW)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:MOORE
Last Name:ZEGEL
Suffix:
Gender:F
Credentials:MSW
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 855
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04841-0855
Mailing Address - Country:US
Mailing Address - Phone:207-596-5844
Mailing Address - Fax:
Practice Address - Street 1:417 MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841
Practice Address - Country:US
Practice Address - Phone:207-596-5844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC4771104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME016803OtherANTHEM BCBS
ME7240298OtherAETNA
MEZEMM5495Medicare ID - Type Unspecified