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NPI Code Detail

MEDICARE: CHRISTOPHER MCINNIS LCSW

MEDICARE: CHRISTOPHER MCINNIS 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
11041C0700XClinical Social WorkerLC11536ME

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1730273897
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTOPHER MCINNIS LCSW
Provider Business Mailing Address
First Line : PO BOX 1599
Second Line :
City : BANGOR
State : ME
Zip : 04402-1599
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1012 UNION ST
Second Line : PENOBSCOT COMMUNITY HEALTH CENTER
City : BANGOR
State : ME
Zip : 04401-3060
Country : US
Telephone Number : 207-404-8100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2006
Last Update Date : 04/19/2016

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Directions to “ CHRISTOPHER MCINNIS LCSW” Practice Location

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