Healthcare Provider Details

I. General information

NPI: 1780853895
Provider Name (Legal Business Name): JOHN GLABERE III CADC & MHRT-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 EDGEMONT DR
PRESQUE ISLE ME
04769-2036
US

IV. Provider business mailing address

1 EDGEMONT DR
PRESQUE ISLE ME
04769-2036
US

V. Phone/Fax

Practice location:
  • Phone: 207-764-3319
  • Fax: 207-768-5377
Mailing address:
  • Phone: 207-764-3319
  • Fax: 207-768-5377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCAC4112
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: