Provider Demographics
NPI:1386959401
Name:GROSVENOR, LOIS KATHLEEN (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:KATHLEEN
Last Name:GROSVENOR
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:WATERBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04087
Mailing Address - Country:US
Mailing Address - Phone:207-247-9000
Mailing Address - Fax:207-247-6109
Practice Address - Street 1:82 BENNETT HILL RD
Practice Address - Street 2:
Practice Address - City:EAST WATERBORO
Practice Address - State:ME
Practice Address - Zip Code:04030-5307
Practice Address - Country:US
Practice Address - Phone:207-247-9000
Practice Address - Fax:207-247-6109
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC94141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical