Healthcare Provider Details

I. General information

NPI: 1427946987
Provider Name (Legal Business Name): MATTHEW RICKER CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2025
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 AIRPORT RD
WATERVILLE ME
04901-4524
US

IV. Provider business mailing address

PO BOX 4
SOLON ME
04979-0004
US

V. Phone/Fax

Practice location:
  • Phone: 207-872-0639
  • Fax:
Mailing address:
  • Phone: 207-672-6530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCAC8927
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: