Provider Demographics
NPI:1386740561
Name:HUME, JUDD WILLIAM (LADC)
Entity type:Individual
Prefix:MR
First Name:JUDD
Middle Name:WILLIAM
Last Name:HUME
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-1908
Mailing Address - Country:US
Mailing Address - Phone:207-221-2292
Mailing Address - Fax:207-221-2297
Practice Address - Street 1:2300 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-1908
Practice Address - Country:US
Practice Address - Phone:207-221-2292
Practice Address - Fax:207-221-2297
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC1089101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME301400099Medicaid