Provider Demographics
NPI:1205671880
Name:DUBOIS, TYLER ANTONIA CAPONE (LMSW-CC)
Entity type:Individual
Prefix:MS
First Name:TYLER
Middle Name:ANTONIA CAPONE
Last Name:DUBOIS
Suffix:
Gender:X
Credentials:LMSW-CC
Other - Prefix:MS
Other - First Name:TYLER
Other - Middle Name:ANTONIA
Other - Last Name:CAPONE DUBOIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW-CC
Mailing Address - Street 1:50 PINE ST
Mailing Address - Street 2:
Mailing Address - City:ORONO
Mailing Address - State:ME
Mailing Address - Zip Code:04473-4054
Mailing Address - Country:US
Mailing Address - Phone:207-631-1449
Mailing Address - Fax:
Practice Address - Street 1:700 MOUNT HOPE AVE STE 320
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5680
Practice Address - Country:US
Practice Address - Phone:207-941-2952
Practice Address - Fax:207-941-2955
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC23683104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker