Healthcare Provider Details

I. General information

NPI: 1760850564
Provider Name (Legal Business Name): RENEE DUBOIS LCSW, CADC, CCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2015
Last Update Date: 02/05/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 LIVEWELL DR
KENNEBUNK ME
04043-6762
US

IV. Provider business mailing address

6 ELIJAH JAMES DR UNIT 101
SACO ME
04072-1686
US

V. Phone/Fax

Practice location:
  • Phone: 207-467-8988
  • Fax:
Mailing address:
  • Phone: 207-651-1662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCAC6252
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberMC15429
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC18147
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: