Provider Demographics
NPI:1912018409
Name:COOMBS, CATHERINE DELIA (LCSW)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:DELIA
Last Name:COOMBS
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 1:22 ASH ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:ME
Mailing Address - Zip Code:04344-1639
Mailing Address - Country:US
Mailing Address - Phone:207-441-8656
Mailing Address - Fax:207-621-2320
Practice Address - Street 1:22 ASH ST
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:ME
Practice Address - Zip Code:04344-1639
Practice Address - Country:US
Practice Address - Phone:207-441-8656
Practice Address - Fax:207-621-2320
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC62991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME273930099Medicaid
ME273930099Medicaid