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NPI Code Detail

MEDICARE: MR. DOUGLAS L POPPER LCSW

MEDICARE: MR. DOUGLAS L POPPER 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 Worker44SC05517600NJ
21041C0700XClinical Social WorkerLC14004ME

General Provider Information

NPI Number : 1760709257
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DOUGLAS L POPPER LCSW
Provider Business Mailing Address
First Line : 52 WESCOTT ST
Second Line :
City : FALMOUTH
State : ME
Zip : 04105-1625
Country : US
Telephone Number : 201-741-0102
Fax Number :
Provider Business Practice Location Address
First Line : 345 COTTAGE RD
Second Line :
City : SOUTH PORTLAND
State : ME
Zip : 04106-3919
Country : US
Telephone Number : 201-741-0102
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2010
Last Update Date : 12/19/2016

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