Healthcare Provider Details

I. General information

NPI: 1588955959
Provider Name (Legal Business Name): JAMES M PEASE LMSW-CC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 04/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

741 WARREN AVE
PORTLAND ME
04103-1007
US

IV. Provider business mailing address

PO BOX 150
WESTBROOK ME
04098-0150
US

V. Phone/Fax

Practice location:
  • Phone: 207-879-6165
  • Fax: 207-879-7466
Mailing address:
  • Phone: 207-879-6165
  • Fax: 207-879-7466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberMC12245
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: