Healthcare Provider Details

I. General information

NPI: 1912956459
Provider Name (Legal Business Name): CLAYNE M CHASE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 02/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

393 SABATTUS ST
LEWISTON ME
04240-5439
US

IV. Provider business mailing address

PO BOX 4140
BOSTON MA
02241-4140
US

V. Phone/Fax

Practice location:
  • Phone: 207-782-9551
  • Fax: 207-784-6826
Mailing address:
  • Phone: 207-777-8974
  • Fax: 207-777-8946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC5762
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: