Provider Demographics
NPI:1699769265
Name:BUREAU, JANICE LAVOIE (LCSW, ACSW)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:LAVOIE
Last Name:BUREAU
Suffix:
Gender:F
Credentials:LCSW, ACSW
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 91
Mailing Address - Street 2:
Mailing Address - City:KENTS HILL
Mailing Address - State:ME
Mailing Address - Zip Code:04349-0091
Mailing Address - Country:US
Mailing Address - Phone:207-689-2354
Mailing Address - Fax:207-689-2354
Practice Address - Street 1:444 MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-6737
Practice Address - Country:US
Practice Address - Phone:207-689-2354
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-09
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC96741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME048260OtherANTHEM
MELC9674OtherSTATE LICENSE
ME247580099Medicaid
ME247580099Medicaid