Healthcare Provider Details

I. General information

NPI: 1649057886
Provider Name (Legal Business Name): ERIC PRATT LMSW-CC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2023
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 OCEAN AVE STE 4
PORTLAND ME
04103-4970
US

IV. Provider business mailing address

131 DURHAM RD UNIT B
FREEPORT ME
04032-6826
US

V. Phone/Fax

Practice location:
  • Phone: 207-370-5389
  • Fax:
Mailing address:
  • Phone: 207-314-5499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC22608
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberMC22608
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: