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NPI Code Detail

MEDICARE: MS. MERRILEE DAHM LARSEN LCPC

MEDICARE: MS. MERRILEE DAHM LARSEN LCPC
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
1101YA0400XAddiction (Substance Use Disorder) CounselorCCS4150ME
2101YM0800XMental Health CounselorCC984ME
3101YP2500XProfessional CounselorCC984ME

General Provider Information

NPI Number : 1487893079
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MERRILEE DAHM LARSEN LCPC
Provider Business Mailing Address
First Line : 53 BAXTER BLVD STE 3
Second Line :
City : PORTLAND
State : ME
Zip : 04101-1827
Country : US
Telephone Number : 603-883-0005
Fax Number :
Provider Business Practice Location Address
First Line : 53 BAXTER BLVD STE 3
Second Line :
City : PORTLAND
State : ME
Zip : 04101-1827
Country : US
Telephone Number : 603-883-0005
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2009
Last Update Date : 04/29/2024

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