Provider Demographics
NPI:1871716522
Name:LAGASSE, WILLIAM KEITH (LCSW)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:KEITH
Last Name:LAGASSE
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 1:105 MIDDLE ST STE 2
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7037
Mailing Address - Country:US
Mailing Address - Phone:207-576-9645
Mailing Address - Fax:207-784-6021
Practice Address - Street 1:105 MIDDLE ST STE 2
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7037
Practice Address - Country:US
Practice Address - Phone:207-576-9645
Practice Address - Fax:207-784-6021
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC115621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical