Healthcare Provider Details

I. General information

NPI: 1649159401
Provider Name (Legal Business Name): SEANTEL RENEE DOUFFET LMSW-CC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SEANTEL RENEE GOODMAN

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 CEDAR ST
BANGOR ME
04401-6433
US

IV. Provider business mailing address

42 CEDAR ST
BANGOR ME
04401-6433
US

V. Phone/Fax

Practice location:
  • Phone: 207-922-4600
  • Fax:
Mailing address:
  • Phone: 207-922-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberMC25126
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: