Provider Demographics
NPI:1982079794
Name:CRAIG, STEPHEN N (LCSW)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:N
Last Name:CRAIG
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MMP INTERNAL MEDICINE AND PEDIATRICS
Mailing Address - Street 2:22 BRAMHALL STREET
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102
Mailing Address - Country:US
Mailing Address - Phone:207-662-2911
Mailing Address - Fax:
Practice Address - Street 1:MMP INTERNAL MEDICINE AND PEDIATRICS
Practice Address - Street 2:22 BRAMHALL STREET
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102
Practice Address - Country:US
Practice Address - Phone:207-662-2911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-04
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC15650104100000X
MELC198291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker