Basic Information
| Provider Information | |||||||||
| NPI: | 1962627539 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MICHAUD | ||||||||
| FirstName: | RACHEL | ||||||||
| MiddleName: | J | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11 W MAIN ST | ||||||||
| Address2: | STE 103 | ||||||||
| City: | FORT KENT | ||||||||
| State: | ME | ||||||||
| PostalCode: | 047431250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078345430 | ||||||||
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| Practice Location | |||||||||
| Address1: | 31 MARKET ST | ||||||||
| Address2: | |||||||||
| City: | FORT KENT | ||||||||
| State: | ME | ||||||||
| PostalCode: | 047431418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078345430 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2007 | ||||||||
| LastUpdateDate: | 06/12/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | MC10670 | ME | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | LC12287 | ME | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 432391999 | 05 | ME | MEDICAID |