Provider Demographics
NPI:1528690963
Name:HARTFORD, CHERYL DUNN (LADC, LSW)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:DUNN
Last Name:HARTFORD
Suffix:
Gender:F
Credentials:LADC, LSW
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:
Other - Last Name:HODKIEWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 183
Mailing Address - Street 2:
Mailing Address - City:WELD
Mailing Address - State:ME
Mailing Address - Zip Code:04285-0183
Mailing Address - Country:US
Mailing Address - Phone:207-244-7315
Mailing Address - Fax:
Practice Address - Street 1:679 RIVER RD
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:ME
Practice Address - Zip Code:04257-1848
Practice Address - Country:US
Practice Address - Phone:207-357-9597
Practice Address - Fax:207-507-1355
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC6892101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)