Provider Demographics
NPI:1184275059
Name:SHAROOD, EDWARD L (LCPC-C, CADA, DEEP)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:L
Last Name:SHAROOD
Suffix:
Gender:M
Credentials:LCPC-C, CADA, DEEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 HOLLAND RD
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-6296
Mailing Address - Country:US
Mailing Address - Phone:207-494-3900
Mailing Address - Fax:
Practice Address - Street 1:1662 POST RD BLDG 2
Practice Address - Street 2:
Practice Address - City:WELLS
Practice Address - State:ME
Practice Address - Zip Code:04090-4638
Practice Address - Country:US
Practice Address - Phone:207-494-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-23
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC6966101YA0400X
MEXL5297101YM0800X
MEXL5296101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health