Provider Demographics
NPI:1760566814
Name:DEE, MICHAEL R (LCSW, CADC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:R
Last Name:DEE
Suffix:
Gender:M
Credentials:LCSW, CADC
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:300 SOUTHBOROUGH DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-6914
Mailing Address - Country:US
Mailing Address - Phone:207-661-2018
Mailing Address - Fax:207-661-2033
Practice Address - Street 1:235 MAIN ST
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-2411
Practice Address - Country:US
Practice Address - Phone:207-294-8693
Practice Address - Fax:207-294-8696
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MECAC7107101YA0400X
MA1136201041C0700X
MELC159561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEE400368226Medicare PIN