Provider Demographics
NPI:1528366408
Name:RICH, CECILY H (LICENSED ALCOHOL DRU)
Entity Type:Individual
Prefix:MS
First Name:CECILY
Middle Name:H
Last Name:RICH
Suffix:
Gender:F
Credentials:LICENSED ALCOHOL DRU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SEA GARDEN CIR
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-7421
Mailing Address - Country:US
Mailing Address - Phone:207-329-5615
Mailing Address - Fax:
Practice Address - Street 1:1 SEA GARDEN CIR
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-7421
Practice Address - Country:US
Practice Address - Phone:207-329-5615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-02
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC4288101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)