Healthcare Provider Details

I. General information

NPI: 1104854827
Provider Name (Legal Business Name): RICHARD P CASTONGUAY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 FLANDERS LN
WASHINGTON ME
04574-4017
US

IV. Provider business mailing address

16 FLANDERS LN
WASHINGTON ME
04574-4017
US

V. Phone/Fax

Practice location:
  • Phone: 207-845-2701
  • Fax:
Mailing address:
  • Phone: 207-845-2701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC743
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: