Provider Demographics
NPI:1003819962
Name:MAY, CHARLES ROBERT (LCSW)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:ROBERT
Last Name:MAY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:CHAS.
Other - Middle Name:R
Other - Last Name:MAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 95
Mailing Address - Street 2:
Mailing Address - City:WISCASSET
Mailing Address - State:ME
Mailing Address - Zip Code:04578-0095
Mailing Address - Country:US
Mailing Address - Phone:207-882-6671
Mailing Address - Fax:207-882-6671
Practice Address - Street 1:71 MAIN ST
Practice Address - Street 2:
Practice Address - City:WISCASSET
Practice Address - State:ME
Practice Address - Zip Code:04578-4136
Practice Address - Country:US
Practice Address - Phone:207-882-6671
Practice Address - Fax:207-882-6671
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC9131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
05829OtherCIGNA BEHAVIORAL HEALTH
017767OtherANTHEM
MA MM3557Medicare ID - Type UnspecifiedMEDICARE