Provider Demographics
NPI:1871221101
Name:TAYLOR, ROBERT (LCSW, LADC, CCS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:LCSW, LADC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 SETTLER RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-4046
Mailing Address - Country:US
Mailing Address - Phone:978-398-1728
Mailing Address - Fax:
Practice Address - Street 1:1250 FOREST AVE STE 201
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-6403
Practice Address - Country:US
Practice Address - Phone:207-370-5458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-14
Last Update Date:2024-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC8168101YA0400X
MELC237841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty