Provider Demographics
NPI:1972620656
Name:DESCHAINE, DENISE GAYLE (LSW)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:GAYLE
Last Name:DESCHAINE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 TATE RD.
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:ME
Mailing Address - Zip Code:04427
Mailing Address - Country:US
Mailing Address - Phone:207-941-2855
Mailing Address - Fax:207-941-2835
Practice Address - Street 1:1066 KENDUSKEAG AVE
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401
Practice Address - Country:US
Practice Address - Phone:207-941-2855
Practice Address - Fax:207-941-2835
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELS8204104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker