Provider Demographics
NPI:1467486720
Name:MARASCO, E. DENNIS (MDIV)
Entity Type:Individual
Prefix:MR
First Name:E. DENNIS
Middle Name:
Last Name:MARASCO
Suffix:
Gender:M
Credentials:MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CUMBERLAND PL
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5083
Mailing Address - Country:US
Mailing Address - Phone:207-433-5253
Mailing Address - Fax:207-217-6587
Practice Address - Street 1:1 CUMBERLAND PL
Practice Address - Street 2:SUITE 104
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5083
Practice Address - Country:US
Practice Address - Phone:207-433-5253
Practice Address - Fax:207-217-6587
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC3376101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional