Provider Demographics
NPI:1346488731
Name:SCOVIL, SEAN STEWART
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:STEWART
Last Name:SCOVIL
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 1:14 COOMBS ST
Mailing Address - Street 2:BANGOR
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5401
Mailing Address - Country:US
Mailing Address - Phone:207-945-3064
Mailing Address - Fax:
Practice Address - Street 1:40 SUMMER ST
Practice Address - Street 2:COMMUNITY CARE
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6446
Practice Address - Country:US
Practice Address - Phone:297-945-4240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEME511784101YA0400X
MEME5127541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)