Provider Demographics
NPI:1518014422
Name:BUESCHER, THOMAS MICHAEL (LCSW)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MICHAEL
Last Name:BUESCHER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:11 MAPLE JUICE LN
Mailing Address - Street 2:
Mailing Address - City:CUSHING
Mailing Address - State:ME
Mailing Address - Zip Code:04563-3725
Mailing Address - Country:US
Mailing Address - Phone:207-691-8129
Mailing Address - Fax:207-594-0922
Practice Address - Street 1:120 TILLSON AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841-3451
Practice Address - Country:US
Practice Address - Phone:207-691-8129
Practice Address - Fax:207-594-0922
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC 000037471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME005593Medicare UPIN