Healthcare Provider Details

I. General information

NPI: 1023336450
Provider Name (Legal Business Name): GARY TURGEON LCPC-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2010
Last Update Date: 05/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 ELM ST.
WATERVILLE ME
04901
US

IV. Provider business mailing address

58 ELM ST.
WATERVILLE ME
04901
US

V. Phone/Fax

Practice location:
  • Phone: 207-680-2065
  • Fax: 207-680-2068
Mailing address:
  • Phone: 207-680-2065
  • Fax: 207-680-2068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberXL3611
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: