MEDICARE: SOLSTICE PSYCHOTHERAPY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1821680844
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLSTICE PSYCHOTHERAPY, LLC

Provider Business Mailing Address
First Line	:	64 BEAVER DAM RD
Second Line	:
City	:	NORTH WATERBORO
State	:	ME
Zip	:	04061-4645
Country	:	US
Telephone Number	:	207-331-7328
Fax Number	:

Provider Business Practice Location Address
First Line	:	64 BEAVER DAM RD
Second Line	:
City	:	NORTH WATERBORO
State	:	ME
Zip	:	04061-4645
Country	:	US
Telephone Number	:	207-331-7328
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANMARIE REED
Credential	:	LCSW, CCS
Telephone Number	:	207-331-7328

Provider Enumeration Date	:	02/10/2021
Last Update Date	:	02/11/2021

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