MEDICARE: CARL S. HESSELBART LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LC7541	ME

General Provider Information

NPI Number	:	1447503065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARL S. HESSELBART LCSW

Provider Business Mailing Address
First Line	:	45 GLENWOOD AVE
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04103-3018
Country	:	US
Telephone Number	:	207-671-8879
Fax Number	:

Provider Business Practice Location Address
First Line	:	45 GLENWOOD AVE
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04103-3018
Country	:	US
Telephone Number	:	207-671-8879
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2012
Last Update Date	:	10/19/2012

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