Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | MC7390 | ME |
NPI | 1003141052 |
---|---|
Provider Name | Rodney St. Louis |
First Address | Bangor, ME 04402-0422 |
Second Address | Bangor, ME 04401-0000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2009 |
Last Update Date | 08/10/2009 |