Basic Information
| Provider Information | |||||||||
| NPI: | 1801554423 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRODEUR | ||||||||
| FirstName: | RACHEL | ||||||||
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| Credential: | LMSW-CC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 35 E SIDE TRL | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049634446 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 67 EUSTIS PKWY | ||||||||
| Address2: | |||||||||
| City: | WATERVILLE | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049015173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078732136 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2021 | ||||||||
| LastUpdateDate: | 12/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | MC20456 | ME | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.