Provider Demographics
NPI:1275724288
Name:HODGDON, SHAWN KENNETH
Entity Type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:KENNETH
Last Name:HODGDON
Suffix:
Gender:M
Credentials:
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 251
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:ME
Mailing Address - Zip Code:04351-0251
Mailing Address - Country:US
Mailing Address - Phone:207-512-3151
Mailing Address - Fax:888-293-3442
Practice Address - Street 1:726 WESTERN AVENUE
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:ME
Practice Address - Zip Code:04351
Practice Address - Country:US
Practice Address - Phone:207-512-3151
Practice Address - Fax:888-293-3442
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC111051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical