Provider Demographics
NPI:1346452646
Name:OUIMETTE, DEBRA A (PHD, LADC, CASAC,SAP)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:A
Last Name:OUIMETTE
Suffix:
Gender:F
Credentials:PHD, LADC, CASAC,SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 IDLEWILD AVE
Mailing Address - Street 2:
Mailing Address - City:OLD ORCHARD BEACH
Mailing Address - State:ME
Mailing Address - Zip Code:04064-1917
Mailing Address - Country:US
Mailing Address - Phone:207-205-7556
Mailing Address - Fax:
Practice Address - Street 1:11 BAXTER BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-1801
Practice Address - Country:US
Practice Address - Phone:207-775-5671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY19061101YA0400X
MELC3363101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)