Healthcare Provider Details

I. General information

NPI: 1063046084
Provider Name (Legal Business Name): BENJAMIN WOLFSON RICHARDS LCSW, LADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BENJAMIN ARTHUR BAIRD LCSW, LADC

II. Dates (important events)

Enumeration Date: 02/28/2020
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183 STATE ST STE 4
AUGUSTA ME
04330-6455
US

IV. Provider business mailing address

PO BOX 61
JEFFERSON ME
04348-0061
US

V. Phone/Fax

Practice location:
  • Phone: 207-512-6855
  • Fax:
Mailing address:
  • Phone: 207-512-6855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC21678
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: