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NPI Code Detail

MEDICARE: MR. PAUL P OUELLETTE LCSW

MEDICARE: MR. PAUL P OUELLETTE LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorLC4793ME

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1027598OTHERMEBCBS

General Provider Information

NPI Number : 1588673040
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. PAUL P OUELLETTE LCSW
Provider Business Mailing Address
First Line : PO BOX 6667
Second Line :
City : PORTLAND
State : ME
Zip : 04103-6667
Country : US
Telephone Number : 207-772-5550
Fax Number :
Provider Business Practice Location Address
First Line : 83 NOYES ST
Second Line :
City : PORTLAND
State : ME
Zip : 04103-4436
Country : US
Telephone Number : 207-772-5550
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/05/2006
Last Update Date : 07/08/2007

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