Healthcare Provider Details

I. General information

NPI: 1669199758
Provider Name (Legal Business Name): TOSH CHABOT ALSAGOFF LCPC-C, ATR-P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NATASHA NICOLE CHABOT

II. Dates (important events)

Enumeration Date: 10/20/2022
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 MAIN ST
SOUTH PORTLAND ME
04106
US

IV. Provider business mailing address

37 SEWALL ROAD
SOUTH BERWICK ME
03908
US

V. Phone/Fax

Practice location:
  • Phone: 207-712-1181
  • Fax:
Mailing address:
  • Phone: 207-752-7762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number22-405
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberXL6759
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: