Provider Demographics
NPI:1609184654
Name:BRUNEAU, RANDI-ANNE (LCSW, CADC, CCS)
Entity Type:Individual
Prefix:
First Name:RANDI-ANNE
Middle Name:
Last Name:BRUNEAU
Suffix:
Gender:F
Credentials:LCSW, CADC, CCS
Other - Prefix:
Other - First Name:RANDI-ANNE
Other - Middle Name:
Other - Last Name:SHEEHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, CADC, CCS
Mailing Address - Street 1:14 MAINE ST
Mailing Address - Street 2:STE 205
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2026
Mailing Address - Country:US
Mailing Address - Phone:207-798-6800
Mailing Address - Fax:
Practice Address - Street 1:17 BISHOP ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-2659
Practice Address - Country:US
Practice Address - Phone:207-523-9298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC4635101YA0400X
MELC124731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEE400172101Medicare PIN
ME001895003Medicare PIN