Individual
MR. RICHARD ALAN WAITZKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW LCSW
Contact information
Practice address
12 GAY STREET, PORTLAND, ME 04103
(207) 774-5025
Mailing address
12 GAY STREET, PORTLAND, ME 04103
(207) 774-5025
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC1096
ME
Other
Enumeration date
03/15/2007
Last updated
07/08/2007
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