Provider Demographics
NPI:1952447179
Name:LEVESQUE, DOUGLAS D (LCSW, LADS, CCS)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:D
Last Name:LEVESQUE
Suffix:
Gender:M
Credentials:LCSW, LADS, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BOLDUC AVE
Mailing Address - Street 2:
Mailing Address - City:FORT KENT
Mailing Address - State:ME
Mailing Address - Zip Code:04743-1602
Mailing Address - Country:US
Mailing Address - Phone:207-834-3971
Mailing Address - Fax:207-834-3837
Practice Address - Street 1:12 BOLDUC AVE
Practice Address - Street 2:
Practice Address - City:FORT KENT
Practice Address - State:ME
Practice Address - Zip Code:04743-1602
Practice Address - Country:US
Practice Address - Phone:207-834-3971
Practice Address - Fax:207-834-3837
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECCS44421041C0700X
MELC35511041C0700X
MELC127341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431555999Medicaid