Theriault, Shane Edward

Theriault, Shane Edward is an individual health care provider with primary practice located at 4 Lombard Rd. , Caribou ME 04736-0748. He recently has only one registered license in Behavioral Health & Social Service Providers / Social Worker, which is considered as his primary health care specialty. Theriault, Shane Edward can be contacted via phone (207) 498-2575.

Contact Information

Primary practice address
4 Lombard Rd. Caribou ME 04736-0748
Phone: (207) 498-2575
Fax: (207) 492-2410
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Social Worker 104100000X LSX8780 Maine

Profile Details

NPI number 1649397928
LBN Legal business name Theriault, Shane Edward
Credentials LSW-C
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 23rd, 2007
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1649397928 NPPES
Maine Other LSX8780 LISCENSE NUMBER

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