Provider Demographics
NPI:1194779942
Name:CHASE, CYNTHIA MARIE (LCPC, LADC, CCS)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:MARIE
Last Name:CHASE
Suffix:
Gender:F
Credentials:LCPC, LADC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:TOPSHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04086-1717
Mailing Address - Country:US
Mailing Address - Phone:207-729-1803
Mailing Address - Fax:207-777-8669
Practice Address - Street 1:39 BARIBEAU DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-3242
Practice Address - Country:US
Practice Address - Phone:207-522-2073
Practice Address - Fax:207-729-1803
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC1723101YM0800X
MELC1491101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME048265OtherANTHEM