Basic Information
| Provider Information | |||||||||
| NPI: | 1376089813 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CONTEH | ||||||||
| FirstName: | OMAR | ||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
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| OtherLastName: | CONTEH | ||||||||
| OtherFirstName: | OMAR | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | MR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LMSW-CC | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 268 STILLWATER AVE | ||||||||
| Address2: | |||||||||
| City: | BANGOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 044013945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079736100 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 268 STILLWATER AVE | ||||||||
| Address2: | |||||||||
| City: | BANGOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 044013945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079736100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2017 | ||||||||
| LastUpdateDate: | 01/09/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | LM15608 | ME | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.