Provider Demographics
NPI:1447200324
Name:DUBAY, ADAM L (MA LCPC)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:L
Last Name:DUBAY
Suffix:
Gender:M
Credentials:MA LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 ARLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04046-6336
Mailing Address - Country:US
Mailing Address - Phone:207-590-9701
Mailing Address - Fax:
Practice Address - Street 1:23 WATER ST
Practice Address - Street 2:SUITE 3
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-5119
Practice Address - Country:US
Practice Address - Phone:207-284-1173
Practice Address - Fax:207-284-2555
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC 2096101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME046753OtherANTHEM BX/BS
ME247540000Medicaid