Healthcare Provider Details

I. General information

NPI: 1609029883
Provider Name (Legal Business Name): RICHARD GAUVIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2008
Last Update Date: 10/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 GRANITE ST
MEXICO ME
04257-1620
US

IV. Provider business mailing address

52 PENNACOOK RD
RUMFORD ME
04276-3446
US

V. Phone/Fax

Practice location:
  • Phone: 207-357-9946
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberXL3138
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: