Basic Information
Provider Information
NPI: 1003141052
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ST. LOUIS
FirstName: RODNEY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: LMSW-CC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: P.O. BOX 422
Address2: ACADIA HOSPITAL CORP.
City: BANGOR
State: ME
PostalCode: 044020422
CountryCode: US
TelephoneNumber: 2079736100
FaxNumber: 2079736109
Practice Location
Address1: 268 STILLWATER AVENUE
Address2: ACADIA HOSPITAL CORP.
City: BANGOR
State: ME
PostalCode: 044010000
CountryCode: US
TelephoneNumber: 2079736100
FaxNumber: 2079736109
Other Information
ProviderEnumerationDate: 10/08/2009
LastUpdateDate: 10/08/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700XMC7390MEY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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