Provider Demographics
NPI:1750635538
Name:LAGASSE, RHEA J (LMSW-CC)
Entity Type:Individual
Prefix:
First Name:RHEA
Middle Name:J
Last Name:LAGASSE
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 FOX ST
Mailing Address - Street 2:SUITE101
Mailing Address - City:MADAWASKA
Mailing Address - State:ME
Mailing Address - Zip Code:04756-1352
Mailing Address - Country:US
Mailing Address - Phone:207-728-6341
Mailing Address - Fax:207-728-7762
Practice Address - Street 1:88 FOX ST
Practice Address - Street 2:SUITE101
Practice Address - City:MADAWASKA
Practice Address - State:ME
Practice Address - Zip Code:04756-1352
Practice Address - Country:US
Practice Address - Phone:207-728-6341
Practice Address - Fax:207-728-7762
Is Sole Proprietor?:No
Enumeration Date:2012-11-01
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC13379104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME103850000Medicaid