Healthcare Provider Details

I. General information

NPI: 1124675145
Provider Name (Legal Business Name): SEAN COCHRANE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2019
Last Update Date: 08/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 HILLCREST AVE
RANDOLPH ME
04346-5131
US

IV. Provider business mailing address

901 WASHINGTON AVE STE 100
PORTLAND ME
04103-2842
US

V. Phone/Fax

Practice location:
  • Phone: 207-582-9205
  • Fax: 207-582-4360
Mailing address:
  • Phone: 207-871-1200
  • Fax: 207-871-1232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberMC18246
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: