Provider Demographics
NPI:1316052616
Name:CALDWELL, DOROTHY (LCPC)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:
Other - Last Name:CALDWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:PO BOX 1881
Mailing Address - Street 2:
Mailing Address - City:BUCKSPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04416-1881
Mailing Address - Country:US
Mailing Address - Phone:207-469-1013
Mailing Address - Fax:
Practice Address - Street 1:100 US HWY ONE
Practice Address - Street 2:SUITE 4
Practice Address - City:VERONA ISLAND
Practice Address - State:ME
Practice Address - Zip Code:04416-1881
Practice Address - Country:US
Practice Address - Phone:207-469-1013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC1986101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME227910099OtherMAINECARE PROVIDER