Provider Demographics
NPI:1912946179
Name:NOONAN, RICHARD A (ACSW, LCSW, LADC,MAC)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:A
Last Name:NOONAN
Suffix:
Gender:M
Credentials:ACSW, LCSW, LADC,MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 MAIN ST
Mailing Address - Street 2:SUITE 62
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6397
Mailing Address - Country:US
Mailing Address - Phone:207-942-5800
Mailing Address - Fax:207-942-5858
Practice Address - Street 1:61 MAIN ST
Practice Address - Street 2:SUITE 62
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6397
Practice Address - Country:US
Practice Address - Phone:207-942-5800
Practice Address - Fax:207-942-5858
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC3357101YA0400X
MELC6496101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME041082OtherANTHEM BC/BS
ME321168OtherMHN
ME9174544OtherPHCS
ME2069529OtherCIGNA BEHAV. HEALTH
ME164979OtherVALUEOPTIONS
ME222270000Medicaid
MEIP550438OtherMAGELLAN PROVIDER