Provider Demographics
NPI:1992729107
Name:NOONAN, DENIS T III (DMIN, LPAC, CEAP,)
Entity type:Individual
Prefix:DR
First Name:DENIS
Middle Name:T
Last Name:NOONAN
Suffix:III
Gender:M
Credentials:DMIN, LPAC, CEAP,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-3912
Mailing Address - Country:US
Mailing Address - Phone:207-879-1409
Mailing Address - Fax:
Practice Address - Street 1:32 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-3912
Practice Address - Country:US
Practice Address - Phone:207-879-1409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEME15101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEME15OtherLICENSED PASTORAL COUNSEL