Provider Demographics
NPI:1831589688
Name:MCCAW, SUSAN (LCPC, CADC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MCCAW
Suffix:
Gender:F
Credentials:LCPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 SPRING HILL RD
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:ME
Mailing Address - Zip Code:04965-3625
Mailing Address - Country:US
Mailing Address - Phone:207-341-0028
Mailing Address - Fax:207-218-0224
Practice Address - Street 1:55 SPRING HILL RD
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:ME
Practice Address - Zip Code:04965-3625
Practice Address - Country:US
Practice Address - Phone:207-341-0028
Practice Address - Fax:207-218-0224
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-02
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC4926101YM0800X
MECAC5746101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)