Provider Demographics
NPI:1053329250
Name:FROST, DANE (LCPC)
Entity Type:Individual
Prefix:DR
First Name:DANE
Middle Name:
Last Name:FROST
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 1:40 FOREST FALLS DR STE 301
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-7010
Mailing Address - Country:US
Mailing Address - Phone:207-604-0987
Mailing Address - Fax:301-329-2315
Practice Address - Street 1:40 FOREST FALLS DR STE 301
Practice Address - Street 2:
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-7010
Practice Address - Country:US
Practice Address - Phone:207-604-0987
Practice Address - Fax:301-329-2315
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC1811101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME218070099Medicaid