Provider Demographics
NPI:1780992008
Name:DAGGETT, DOUGLAS EDMUND (LMSW)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:EDMUND
Last Name:DAGGETT
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 HOLBROOK ST
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032-1205
Mailing Address - Country:US
Mailing Address - Phone:207-865-4706
Mailing Address - Fax:
Practice Address - Street 1:30 HOLBROOK ST
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:ME
Practice Address - Zip Code:04032-1205
Practice Address - Country:US
Practice Address - Phone:207-865-4706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELM41881041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME104150200XMedicaid