Individual
DR. BRUCE CONRAD ST. THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ED.,D.
Contact information
Practice address
545 WESTBROOK ST, SOUTH PORTLAND, ME 04106-1909
(207) 772-4789
Mailing address
545 WESTBROOK ST, SOUTH PORTLAND, ME 04106-1909
(207) 772-4789
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
CC458
ME
106H00000X
Marriage & Family Therapist
MF301
ME
Other
Enumeration date
01/26/2010
Last updated
01/26/2010
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