Provider Demographics
NPI:1912956459
Name:CHASE, CLAYNE M (LCSW)
Entity type:Individual
Prefix:
First Name:CLAYNE
Middle Name:M
Last Name:CHASE
Suffix:
Gender:M
Credentials:LCSW
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 4140
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-4140
Mailing Address - Country:US
Mailing Address - Phone:207-777-8974
Mailing Address - Fax:207-777-8946
Practice Address - Street 1:393 SABATTUS ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-5439
Practice Address - Country:US
Practice Address - Phone:207-782-9551
Practice Address - Fax:207-784-6826
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC57621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME313300099Medicaid
ME313300099Medicaid