Individual
PHILLIP W REPPOND
Active
Individual
PHILLIP W REPPOND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LCS925
ME
1041C0700X
Clinical Social Worker
Primary
LCS925
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
432427399
—
ME
Enumeration date
06/23/2008
Last updated
09/03/2010
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