Provider Demographics
NPI:1407062367
Name:COMEAU, TRACY STEPHEN (LCPC)
Entity type:Individual
Prefix:MR
First Name:TRACY
Middle Name:STEPHEN
Last Name:COMEAU
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 201
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04274-0201
Mailing Address - Country:US
Mailing Address - Phone:207-754-2233
Mailing Address - Fax:
Practice Address - Street 1:1273 MAINE ST
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:ME
Practice Address - Zip Code:04274-7328
Practice Address - Country:US
Practice Address - Phone:207-754-2233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC3089101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME417100099Medicaid