Healthcare Provider Details

I. General information

NPI: 1225682024
Provider Name (Legal Business Name): MARK R DUBE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2019
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 UNION ST
ROCKLAND ME
04841-2739
US

IV. Provider business mailing address

12 UNION ST
ROCKLAND ME
04841-2739
US

V. Phone/Fax

Practice location:
  • Phone: 844-292-0111
  • Fax: 207-701-4487
Mailing address:
  • Phone: 844-292-0111
  • Fax: 207-701-4487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC19545
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: