Provider Demographics
NPI:1053653808
Name:RIDEOUT, DANIELLE (LADC, CCS)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:RIDEOUT
Suffix:
Gender:F
Credentials:LADC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 BOWDOIN ST
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-8325
Mailing Address - Country:US
Mailing Address - Phone:207-329-2267
Mailing Address - Fax:
Practice Address - Street 1:24 BOWDOIN ST
Practice Address - Street 2:
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-8325
Practice Address - Country:US
Practice Address - Phone:207-329-2267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-20
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC5600101YA0400X
MECAC4968101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)