Ericson, Timothy M

Ericson, Timothy M is an sole proprietor health care provider with primary practice located at 4 Dane St , Kennebunk ME 04043-7054. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is his primary health care specialty. Ericson, Timothy M can be contacted via phone (207) 985-4211.

Contact Information

Primary practice address
4 Dane St Kennebunk ME 04043-7054
Phone: (207) 985-4211
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X LC683 Maine
Behavioral Health & Social Service Providers / Clinical 1041C0700X LC2045 Maine

Profile Details

NPI number 1720006943
LBN Legal business name Ericson, Timothy M
Credentials LCSW, LADC
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 17th, 2006
Last updated Sep 21st, 2011 - about 14 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 1720006943 NPPES
Maine Other 007005 ANTHEM BLUE CROSS

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