Provider Demographics
NPI:1053418673
Name:RADMORE, DAVID M (LCSW)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:M
Last Name:RADMORE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:20 GEORGE PERLEY RD
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:ME
Mailing Address - Zip Code:04039-5805
Mailing Address - Country:US
Mailing Address - Phone:207-233-1464
Mailing Address - Fax:207-514-8333
Practice Address - Street 1:55 BELL ST STE 1
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-3418
Practice Address - Country:US
Practice Address - Phone:207-233-1464
Practice Address - Fax:207-514-8333
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PACW0171941041C0700X
NYR0558871041C0700X
MELC114801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
000546801Medicare PIN