Provider Demographics
NPI:1053445767
Name:DEVEAU, PHILIP R (LCSW)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:R
Last Name:DEVEAU
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 1:110 MAIN ST
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-3509
Mailing Address - Country:US
Mailing Address - Phone:207-571-3008
Mailing Address - Fax:207-571-3263
Practice Address - Street 1:110 MAIN ST
Practice Address - Street 2:SUITE 1306
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-3509
Practice Address - Country:US
Practice Address - Phone:207-571-3008
Practice Address - Fax:207-571-3263
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC117701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical