Individual
MR. PAUL P OUELLETTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
83 NOYES ST, PORTLAND, ME 04103-4436
(207) 772-5550
Mailing address
PO BOX 6667, PORTLAND, ME 04103-6667
(207) 772-5550
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LC4793
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
027598
BCBS
ME
Enumeration date
08/05/2006
Last updated
07/08/2007
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