Healthcare Provider Details

I. General information

NPI: 1528690963
Provider Name (Legal Business Name): CHERYL DUNN HARTFORD LADC, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHERYL HODKIEWICZ

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 02/04/2020
Certification Date: 02/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

679 RIVER RD
MEXICO ME
04257-1848
US

IV. Provider business mailing address

PO BOX 183
WELD ME
04285-0183
US

V. Phone/Fax

Practice location:
  • Phone: 207-357-9597
  • Fax: 207-507-1355
Mailing address:
  • Phone: 207-244-7315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLC6892
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: