Provider Demographics
NPI:1154590412
Name:CHAFFEE, THEODORE EMERSON (LMFT)
Entity type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:EMERSON
Last Name:CHAFFEE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-3914
Mailing Address - Country:US
Mailing Address - Phone:207-773-6772
Mailing Address - Fax:207-772-8400
Practice Address - Street 1:17 SOUTH ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-3914
Practice Address - Country:US
Practice Address - Phone:207-773-6772
Practice Address - Fax:207-772-8400
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMF529106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist