Doctor Name: | MR. ROBERT V OLDHAM |
NPI Number: | 1427195296 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LCPC-C |
License Number: | XL2993 |
Business Practice Address: | 869 Deerwander Rd Hollis Center, ME - 040423609 |
Business Phone Number: | 2072052436 |
Business Fax Number: | 2079294111 |
Mailing Address: | 869 Deerwander Rd, HOLLIS CENTER |
State: | ME |
Postal Code: | 040423609 |
Phone Number: | 2079295711 |
Fax Number: | 2079295711 |
NPI Enumeration Date: | 01/31/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | XL2993 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ME |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |