Provider Demographics
NPI:1205865128
Name:BRAGA, PAULO DANIEL (LCPC LCCS)
Entity type:Individual
Prefix:
First Name:PAULO
Middle Name:DANIEL
Last Name:BRAGA
Suffix:
Gender:M
Credentials:LCPC LCCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 BOUNDARY RD
Mailing Address - Street 2:
Mailing Address - City:STANDISH
Mailing Address - State:ME
Mailing Address - Zip Code:04084
Mailing Address - Country:US
Mailing Address - Phone:207-642-4956
Mailing Address - Fax:207-642-4956
Practice Address - Street 1:110 TANDBERG TRAIL
Practice Address - Street 2:RTE 115
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062
Practice Address - Country:US
Practice Address - Phone:207-899-5534
Practice Address - Fax:207-642-4956
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2008-03-11
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2008-03-11
Provider Licenses
StateLicense IDTaxonomies
MECCS3217101YA0400X
MELCPC1296101YM0800X
MECC1296101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)