Provider Demographics
NPI:1164296877
Name:MCINERNEY, DAVID FRANCIS (LADC MAINE LC 8634)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:FRANCIS
Last Name:MCINERNEY
Suffix:
Gender:M
Credentials:LADC MAINE LC 8634
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 175
Mailing Address - Street 2:
Mailing Address - City:MILLINOCKET
Mailing Address - State:ME
Mailing Address - Zip Code:04462-0175
Mailing Address - Country:US
Mailing Address - Phone:218-460-8320
Mailing Address - Fax:
Practice Address - Street 1:57 PENOBSCOT AVE
Practice Address - Street 2:
Practice Address - City:MILLINOCKET
Practice Address - State:ME
Practice Address - Zip Code:04462-1320
Practice Address - Country:US
Practice Address - Phone:800-349-5006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME86345101YA0400X
ME8634101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty