Healthcare Provider Details

I. General information

NPI: 1760441372
Provider Name (Legal Business Name): WILLIAM F MACOMBER JR. L.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 04/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 LINCOLN ST STE T1
SACO ME
04072-3113
US

IV. Provider business mailing address

333 LINCOLN ST STE T1
SACO ME
04072-3113
US

V. Phone/Fax

Practice location:
  • Phone: 207-571-8256
  • Fax: 207-510-7674
Mailing address:
  • Phone: 207-571-8256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC7873
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: