Healthcare Provider Details

I. General information

NPI: 1609283514
Provider Name (Legal Business Name): CASEY LARCOMBE CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2014
Last Update Date: 09/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 BUCKSPORT RD
ELLSWORTH ME
04605
US

IV. Provider business mailing address

PO BOX 1018
CARIBOU ME
04736-1018
US

V. Phone/Fax

Practice location:
  • Phone: 207-667-6890
  • Fax: 207-667-6457
Mailing address:
  • Phone: 207-498-6431
  • Fax: 207-492-3181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCAC5272
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: