Healthcare Provider Details

I. General information

NPI: 1366354565
Provider Name (Legal Business Name): RHETT BENJAMIN MOSS MERCURY LMSW-CC
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 LISBON ST STE 201
LEWISTON ME
04240-7248
US

IV. Provider business mailing address

179 LISBON ST STE 201
LEWISTON ME
04240-7248
US

V. Phone/Fax

Practice location:
  • Phone: 207-200-7952
  • Fax:
Mailing address:
  • Phone: 207-200-7952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberMC26470
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: