Provider Demographics
NPI:1942585773
Name:STUDWELL, PHILIP WILLIAM (LCSW)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:WILLIAM
Last Name:STUDWELL
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 1:171 AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-2131
Mailing Address - Country:US
Mailing Address - Phone:207-874-8150
Mailing Address - Fax:207-874-8272
Practice Address - Street 1:171 AUBURN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-2131
Practice Address - Country:US
Practice Address - Phone:207-874-8150
Practice Address - Fax:207-874-8272
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC12631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical