Provider Demographics
NPI:1265839369
Name:GEORGE, PRIYADARSHI (LCSW)
Entity Type:Individual
Prefix:
First Name:PRIYADARSHI
Middle Name:
Last Name:GEORGE
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 1:1227 PRESCOTT RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:ME
Mailing Address - Zip Code:04351-3010
Mailing Address - Country:US
Mailing Address - Phone:207-623-2180
Mailing Address - Fax:
Practice Address - Street 1:1227 PRESCOTT RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:ME
Practice Address - Zip Code:04351-3010
Practice Address - Country:US
Practice Address - Phone:207-623-2180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-04
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC16891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEPENDINGMedicaid
MEPENDINGMedicaid