Provider Demographics
NPI:1841569175
Name:HARVELL, SAMUEL C (LCSW)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:C
Last Name:HARVELL
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 1:1321 WASHINGTON AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-3675
Mailing Address - Country:US
Mailing Address - Phone:603-361-5174
Mailing Address - Fax:207-221-9986
Practice Address - Street 1:1321 WASHINGTON AVE STE 304
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-3675
Practice Address - Country:US
Practice Address - Phone:603-361-5174
Practice Address - Fax:207-221-9986
Is Sole Proprietor?:No
Enumeration Date:2011-12-15
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC144981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEE400172168Medicare PIN
MEE400129928Medicare PIN