Organization
SUPPORTIVE CARE OF MAINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAPHAEL LICHTSHCEIN (PRESIDENT)
(718) 298-4375
Entity
Organization
Contact information
Practice address
516 MOUNT HOPE AVE, BANGOR, ME 04401-4215
(718) 298-2753
Mailing address
27 RANDOLPH RD, HOWELL, NJ 07731-8611
(718) 298-4375
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
10/03/2022
Last updated
10/03/2022
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