Provider Demographics
NPI:1700121092
Name:BUZZELL-CLIMO, MATTHEW CARLOS (LCPC-C)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:CARLOS
Last Name:BUZZELL-CLIMO
Suffix:
Gender:M
Credentials:LCPC-C
Other - Prefix:
Other - First Name:MATTHEW
Other - Middle Name:CARLOS
Other - Last Name:CLIMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:78 ATLANTIC PL
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2316
Mailing Address - Country:US
Mailing Address - Phone:207-842-7701
Mailing Address - Fax:207-842-7773
Practice Address - Street 1:2 SPRINGBROOK DR
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9443
Practice Address - Country:US
Practice Address - Phone:207-282-1500
Practice Address - Fax:207-282-2581
Is Sole Proprietor?:No
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL4034101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional