Provider Demographics
NPI:1588955959
Name:PEASE, JAMES M (LMSW-CC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:PEASE
Suffix:
Gender:M
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 150
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04098-0150
Mailing Address - Country:US
Mailing Address - Phone:207-879-6165
Mailing Address - Fax:207-879-7466
Practice Address - Street 1:741 WARREN AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-1007
Practice Address - Country:US
Practice Address - Phone:207-879-6165
Practice Address - Fax:207-879-7466
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC122451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical