Provider Demographics
NPI:1740567072
Name:RIGHTMIRE, MYLES J (LCSW, LADC)
Entity Type:Individual
Prefix:
First Name:MYLES
Middle Name:J
Last Name:RIGHTMIRE
Suffix:
Gender:M
Credentials:LCSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:389 CONGRESS ST
Mailing Address - Street 2:ROOM 307
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-3566
Mailing Address - Country:US
Mailing Address - Phone:207-874-8784
Mailing Address - Fax:207-874-8913
Practice Address - Street 1:103 INDIA ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-4211
Practice Address - Country:US
Practice Address - Phone:207-874-8446
Practice Address - Fax:207-756-8087
Is Sole Proprietor?:No
Enumeration Date:2011-11-15
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC127681041C0700X
MELC4928101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)