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NPI Code Detail

MEDICARE: MR. PAUL KENNETH MATTESON MS.ED., L.C.P.C.

MEDICARE: MR. PAUL KENNETH MATTESON MS.ED., L.C.P.C.
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
1101YM0800XMental Health CounselorCC966ME

General Provider Information

NPI Number : 1467595371
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. PAUL KENNETH MATTESON MS.ED., L.C.P.C.
Provider Business Mailing Address
First Line : 243 FICKETT RD
Second Line :
City : POWNAL
State : ME
Zip : 04069-6157
Country : US
Telephone Number : 207-688-4043
Fax Number :
Provider Business Practice Location Address
First Line : 440 FOREST AVE
Second Line :
City : PORTLAND
State : ME
Zip : 04101-2015
Country : US
Telephone Number : 207-753-0135
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2007
Last Update Date : 07/21/2022

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