Provider Demographics
NPI:1275042202
Name:TROST, BRUCE D (LMSW-CC)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:D
Last Name:TROST
Suffix:
Gender:M
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:776 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-8307
Mailing Address - Country:US
Mailing Address - Phone:207-622-5946
Mailing Address - Fax:207-622-4667
Practice Address - Street 1:776 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-8307
Practice Address - Country:US
Practice Address - Phone:207-622-5946
Practice Address - Fax:207-622-4667
Is Sole Proprietor?:No
Enumeration Date:2017-09-21
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC7677101YA0400X
MEMC168501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)