Provider Demographics
NPI:1306688213
Name:CHASE, MATTHEW CLAY
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:CLAY
Last Name:CHASE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 PLUMMER ST
Mailing Address - Street 2:
Mailing Address - City:GARDINER
Mailing Address - State:ME
Mailing Address - Zip Code:04345-2528
Mailing Address - Country:US
Mailing Address - Phone:207-650-9773
Mailing Address - Fax:
Practice Address - Street 1:1 CONSTELLATION WAY STE 101
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-2256
Practice Address - Country:US
Practice Address - Phone:207-956-5977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC7527101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health