Healthcare Provider Details

I. General information

NPI: 1740050434
Provider Name (Legal Business Name): DANIEL N GASPER LCPC LADC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2024
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 MILBRIDGE RD
CHERRYFIELD ME
04622-4403
US

IV. Provider business mailing address

7 SHOP HILL RD
MILBRIDGE ME
04658-3029
US

V. Phone/Fax

Practice location:
  • Phone: 207-530-7774
  • Fax: 207-546-2100
Mailing address:
  • Phone: 207-530-7774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DANIEL N GASPER
Title or Position: OWNER/PROVIDER
Credential: LCPC LADC
Phone: 207-530-7774