Provider Demographics
NPI:1093816795
Name:COLE, JOHN WC (LCSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WC
Last Name:COLE
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 1:1027 SAWYER RD
Mailing Address - Street 2:
Mailing Address - City:CAPE ELIZABETH
Mailing Address - State:ME
Mailing Address - Zip Code:04107-9638
Mailing Address - Country:US
Mailing Address - Phone:207-245-1929
Mailing Address - Fax:888-765-8406
Practice Address - Street 1:131 OCEAN ST
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-3649
Practice Address - Country:US
Practice Address - Phone:207-221-5549
Practice Address - Fax:888-765-8406
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC49671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical