Provider Demographics
NPI:1669741252
Name:POISSON, BERTRAND DAVID (LSW-C)
Entity type:Individual
Prefix:
First Name:BERTRAND
Middle Name:DAVID
Last Name:POISSON
Suffix:
Gender:M
Credentials:LSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:SKOWHEGAN
Mailing Address - State:ME
Mailing Address - Zip Code:04976-4823
Mailing Address - Country:US
Mailing Address - Phone:207-474-8311
Mailing Address - Fax:207-474-8174
Practice Address - Street 1:5 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:SKOWHEGAN
Practice Address - State:ME
Practice Address - Zip Code:04976-4823
Practice Address - Country:US
Practice Address - Phone:207-474-8311
Practice Address - Fax:207-474-8174
Is Sole Proprietor?:No
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELSX12554104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker