Healthcare Provider Details

I. General information

NPI: 1487743886
Provider Name (Legal Business Name): MARC A DIONNE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 10/28/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 WATER ST
WISCASSET ME
04578-4133
US

IV. Provider business mailing address

393 CATHANCE RD
TOPSHAM ME
04086-5517
US

V. Phone/Fax

Practice location:
  • Phone: 207-882-6008
  • Fax:
Mailing address:
  • Phone: 207-841-2566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC11360
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier432381799
Identifier TypeOTHER
Identifier StateME
Identifier IssuerMAINE CARE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: