Healthcare Provider Details

I. General information

NPI: 1841850781
Provider Name (Legal Business Name): BRUCE WEBBER LCSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 06/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 PARK STREET, SUITE 201
LEWISTON ME
04240-7282
US

IV. Provider business mailing address

95 PARK STREET, SUITE 201
LEWISTON ME
04240-7282
US

V. Phone/Fax

Practice location:
  • Phone: 207-939-6082
  • Fax: 207-782-9001
Mailing address:
  • Phone: 207-939-6082
  • Fax: 207-782-9001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name: BRUCE WEBBER
Title or Position: PRESIDENT
Credential: LCSW
Phone: 207-939-6082