Healthcare Provider Details

I. General information

NPI: 1518014422
Provider Name (Legal Business Name): THOMAS MICHAEL BUESCHER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 TILLSON AVE SUITE 201
ROCKLAND ME
04841-3451
US

IV. Provider business mailing address

11 MAPLE JUICE LN
CUSHING ME
04563-3725
US

V. Phone/Fax

Practice location:
  • Phone: 207-691-8129
  • Fax: 207-594-0922
Mailing address:
  • Phone: 207-691-8129
  • Fax: 207-594-0922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC 00003747
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: