Provider Demographics
NPI:1700907508
Name:BOUTIN, EDWARD J (MHRTC)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:J
Last Name:BOUTIN
Suffix:
Gender:M
Credentials:MHRTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 PAINE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:ME
Mailing Address - Zip Code:04422-3419
Mailing Address - Country:US
Mailing Address - Phone:207-285-7854
Mailing Address - Fax:
Practice Address - Street 1:42 CEDAR STREET
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401
Practice Address - Country:US
Practice Address - Phone:207-947-0366
Practice Address - Fax:207-942-4350
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator