Healthcare Provider Details

I. General information

NPI: 1891346185
Provider Name (Legal Business Name): ANDREA CHASSE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2019
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 HATCH DR STE 310
CARIBOU ME
04736-2002
US

IV. Provider business mailing address

180 ACADEMY ST STE 3
PRESQUE ISLE ME
04769-3183
US

V. Phone/Fax

Practice location:
  • Phone: 207-493-3361
  • Fax: 207-492-4889
Mailing address:
  • Phone: 207-554-2352
  • Fax: 207-554-2351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberMC17000
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC19294
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: