Provider Demographics
NPI:1174582548
Name:PINETTE, PAUL DAVID (LCSW)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:DAVID
Last Name:PINETTE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 WATER ST STE 3
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-2724
Mailing Address - Country:US
Mailing Address - Phone:207-284-1173
Mailing Address - Fax:
Practice Address - Street 1:23 WATER ST STE 3
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-2724
Practice Address - Country:US
Practice Address - Phone:207-284-1173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC102061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEME172901Medicare PIN
MEPI-ME1729Medicare PIN