Provider Demographics
NPI:1790302545
Name:BOVE, ANDREW JAMES (LCSW)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JAMES
Last Name:BOVE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 OCEAN HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:CAPE ELIZABETH
Mailing Address - State:ME
Mailing Address - Zip Code:04107-1110
Mailing Address - Country:US
Mailing Address - Phone:207-318-5944
Mailing Address - Fax:
Practice Address - Street 1:55 PORTLAND ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2921
Practice Address - Country:US
Practice Address - Phone:207-775-0026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-27
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC184791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty