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General NPI Number Information
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NPI Number | 1871221101
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Entity Type | Individual
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Provider Name | ROBERT TAYLOR LCSW, LADC, CCS
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Gender | Male
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Dates
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Enumeration Date | 08/14/2022
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Last Update Date | 07/28/2024
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Provider Practice Location Address
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Address Line | 1250 FOREST AVE STE 201
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City | PORTLAND
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State | ME
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Zip | 04103-6403
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Country | US
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Telephone | 207-370-5458
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Fax |
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Provider Business Mailing Address
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Address Line | 145 SETTLER RD
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-4046
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Country | US
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Telephone | 978-398-1728
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LC8168
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC23784
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License Number State | ME
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