Healthcare Provider Details

I. General information

NPI: 1649675844
Provider Name (Legal Business Name): BENJAMIN STRICK LMSW-CC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2014
Last Update Date: 11/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 MONUMENT SQ SUITE 4
PORTLAND ME
04101-4039
US

IV. Provider business mailing address

899 RIVERSIDE ST
PORTLAND ME
04103-1070
US

V. Phone/Fax

Practice location:
  • Phone: 207-871-1211
  • Fax:
Mailing address:
  • Phone: 207-871-1211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberMC15103
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: