Provider Demographics
NPI:1619635992
Name:DYER, JOSHUA KEVIN (CADC)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:KEVIN
Last Name:DYER
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 MIA RDG
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:ME
Mailing Address - Zip Code:04330-2584
Mailing Address - Country:US
Mailing Address - Phone:207-660-1462
Mailing Address - Fax:
Practice Address - Street 1:70 FIRST RANGEWAY
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-5254
Practice Address - Country:US
Practice Address - Phone:207-616-0705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC7641101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)