Organization · NPI-2

Maine Geropsychology, LLC

Clinic/Center, Adult Mental Health · Brunswick, ME

NPI number1144692880
StatusActive
Last updated in NPPESNov 4, 2015

Details

NPI
1144692880
Entity type
Organization (NPI-2)
Legal business name
Maine Geropsychology, LLC
Organization subpart
No
Enumeration date
Oct 21, 2015
Last updated
Nov 4, 2015

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QM0850X Clinic/Center, Adult Mental HealthPS1413MEYes

Practice location

14 Maine St
Suite 111-C
Brunswick, ME 04011-2049

Phone 207-721-8143 · Fax 207-721-8143

Mailing address

14 Maine St
Suite 111-C
Brunswick, ME 04011-2049

Phone 207-721-8143 · Fax 207-721-8143

Authorized official

Martin Morthland
Owner
2077218143

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