Provider Demographics
NPI:1427684372
Name:STANTON, MARY (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:STANTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 WILDERNESS LN
Mailing Address - Street 2:
Mailing Address - City:BOWDOINHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04008-6059
Mailing Address - Country:US
Mailing Address - Phone:207-209-3123
Mailing Address - Fax:
Practice Address - Street 1:110 WILDERNESS LN
Practice Address - Street 2:
Practice Address - City:BOWDOINHAM
Practice Address - State:ME
Practice Address - Zip Code:04008-6059
Practice Address - Country:US
Practice Address - Phone:781-864-9966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-22
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC18106101YM0800X
CALCSW1183381041C0700X
MELC201601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health