Provider Demographics
NPI:1548045982
Name:BREWER-CUSHMAN, HOLLIE RAE (LCSW)
Entity type:Individual
Prefix:MS
First Name:HOLLIE
Middle Name:RAE
Last Name:BREWER-CUSHMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:HOLLIE
Other - Middle Name:RAE
Other - Last Name:BREWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:96 PINE GROVE LN
Mailing Address - Street 2:
Mailing Address - City:ETNA
Mailing Address - State:ME
Mailing Address - Zip Code:04434-3564
Mailing Address - Country:US
Mailing Address - Phone:207-991-1758
Mailing Address - Fax:
Practice Address - Street 1:71 US ROUTE 1 STE E
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7168
Practice Address - Country:US
Practice Address - Phone:207-773-9931
Practice Address - Fax:207-879-5576
Is Sole Proprietor?:No
Enumeration Date:2023-08-25
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC211621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical