Provider Demographics
NPI:1508163221
Name:NEEDHAM, DAVID B (LMSW,CC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:B
Last Name:NEEDHAM
Suffix:
Gender:M
Credentials:LMSW,CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 DOVER RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:ME
Mailing Address - Zip Code:04422-3032
Mailing Address - Country:US
Mailing Address - Phone:207-717-8529
Mailing Address - Fax:207-285-0867
Practice Address - Street 1:1202 DOVER RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:ME
Practice Address - Zip Code:04422-3032
Practice Address - Country:US
Practice Address - Phone:207-717-8529
Practice Address - Fax:207-285-0867
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC68721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical