Provider Demographics
NPI:1629381777
Name:DEGRASSE, BRETT E (LCPC)
Entity Type:Individual
Prefix:MR
First Name:BRETT
Middle Name:E
Last Name:DEGRASSE
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 SPRING RD
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04967-1336
Mailing Address - Country:US
Mailing Address - Phone:207-416-2654
Mailing Address - Fax:
Practice Address - Street 1:143 SPRING RD
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:ME
Practice Address - Zip Code:04967-1336
Practice Address - Country:US
Practice Address - Phone:207-416-2654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC3938101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME435421499Medicaid