Provider Demographics
NPI:1871901249
Name:OLIVER, RICHARD J (LCPC-C)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:OLIVER
Suffix:
Gender:M
Credentials:LCPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 EGRET CV
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-3182
Mailing Address - Country:US
Mailing Address - Phone:207-221-0270
Mailing Address - Fax:
Practice Address - Street 1:16 EGRET CV
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-3182
Practice Address - Country:US
Practice Address - Phone:207-221-0270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL4346101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional