Provider Demographics
NPI:1174929061
Name:DEFOSSE-STROUT, DANIELLE (MSW, MHRT/C)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:DEFOSSE-STROUT
Suffix:
Gender:F
Credentials:MSW, MHRT/C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 LEAVITT AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-4746
Mailing Address - Country:US
Mailing Address - Phone:207-577-0606
Mailing Address - Fax:
Practice Address - Street 1:4 PARK ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7172
Practice Address - Country:US
Practice Address - Phone:207-784-0922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker