MEDICARE: PHILLIP W REPPOND 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	101YM0800X	Mental Health Counselor	LCS925	ME
2	1041C0700X	Clinical Social Worker	LCS925	ME

Other Identifiers

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

General Provider Information

NPI Number	:	1861653859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILLIP W REPPOND LCSW

Provider Business Mailing Address
First Line	:	38 PLYMOUTH DR
Second Line	:
City	:	SACO
State	:	ME
Zip	:	04072-1734
Country	:	US
Telephone Number	:	207-282-4920
Fax Number	:	707-598-1038

Provider Business Practice Location Address
First Line	:	38 PLYMOUTH DR
Second Line	:
City	:	SACO
State	:	ME
Zip	:	04072-1734
Country	:	US
Telephone Number	:	207-282-4920
Fax Number	:	707-598-1038

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

Provider Enumeration Date	:	06/23/2008
Last Update Date	:	09/03/2010

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Directions to “ PHILLIP W REPPOND LCSW” Practice Location

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