Theodore Emerson Chaffee, LMFT

Individual provider Active NPI Marriage & Family Therapist · Portland, ME

NPI 1154590412 · NPPES record last updated Feb 20, 2008

Key facts

NPI
1154590412
Entity type
Individual (NPI type 1)
Primary specialty
Marriage & Family Therapist 106H00000X
License
MF529 (ME)
Practice address
17 South St
Portland, ME 04101-3914
Phone
(207) 773-6772
Fax
(207) 772-8400
NPI assigned
Feb 20, 2008
Sex
Male
Sole proprietor
Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
MF529MEMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Sweetser Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X MF529 ME Yes

Addresses

Primary practice location

17 South St
Portland, ME 04101-3914

Mailing address

17 South St
Portland, ME 04101-3914
Phone (207) 773-6772

Other providers in Portland, ME

All providers in Portland, ME · Marriage & Family Therapist in Maine

Sources for this page

Verify at the official NPI Registry.