Provider Demographics
NPI:1780825919
Name:NADEAU, MICHAEL L
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:NADEAU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 W VIEW DR
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-2040
Mailing Address - Country:US
Mailing Address - Phone:207-939-0460
Mailing Address - Fax:
Practice Address - Street 1:25 W VIEW DR
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-2040
Practice Address - Country:US
Practice Address - Phone:207-939-0460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-18
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC4479101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)