Doctor Name: | JOHN W REIDY |
NPI Number: | 1376773044 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LCSW |
License Number: | LC12053 |
Business Practice Address: | 102 Gordon Farms Rd Gorham, ME - 040382389 |
Business Phone Number: | 2078930386 |
Business Fax Number: | 2078932086 |
Mailing Address: | Po Box 1360, WINDHAM |
State: | ME |
Postal Code: | 040621360 |
Phone Number: | 2078930386 |
Fax Number: | 2078932086 |
NPI Enumeration Date: | 07/16/2009 |
NPI Last Update Date: | 07/16/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | LC12053 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ME |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |