Healthcare Provider Details

I. General information

NPI: 1164296877
Provider Name (Legal Business Name): DAVID FRANCIS MCINERNEY LADC MAINE LC 8634
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2023
Last Update Date: 12/19/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 PENOBSCOT AVE
MILLINOCKET ME
04462-1320
US

IV. Provider business mailing address

PO BOX 175
MILLINOCKET ME
04462-0175
US

V. Phone/Fax

Practice location:
  • Phone: 800-349-5006
  • Fax:
Mailing address:
  • Phone: 218-460-8320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number86345
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number8634
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: