Provider Demographics
NPI:1053891218
Name:PEPIN, MICHAEL (LMSW-CC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:PEPIN
Suffix:
Gender:M
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CASCO TER APT 3
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1524
Mailing Address - Country:US
Mailing Address - Phone:207-355-5101
Mailing Address - Fax:
Practice Address - Street 1:280B GANNETT DR
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-6940
Practice Address - Country:US
Practice Address - Phone:207-828-0048
Practice Address - Fax:207-756-6228
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1053467779101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health