Provider Demographics
NPI:1275733917
Name:GAGNON, ERIN RHEA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:RHEA
Last Name:GAGNON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 FALMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-4536
Mailing Address - Country:US
Mailing Address - Phone:207-632-3008
Mailing Address - Fax:207-874-8150
Practice Address - Street 1:171 AUBURN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-2131
Practice Address - Country:US
Practice Address - Phone:207-874-8150
Practice Address - Fax:207-874-8150
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC133371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431816199Medicare UPIN