Healthcare Provider Details

I. General information

NPI: 1689755530
Provider Name (Legal Business Name): BROADLEAF BEHAVIORAL HEALTH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 04/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 OLD SAWMILL LN
ARUNDEL ME
04046-8164
US

IV. Provider business mailing address

PO BOX 810
WESTBROOK ME
04098-0810
US

V. Phone/Fax

Practice location:
  • Phone: 207-985-8998
  • Fax: 207-985-1281
Mailing address:
  • Phone: 800-595-0033
  • Fax: 207-839-3190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberME1558
License Number StateME

VIII. Authorized Official

Name: DR. DAVID P JONES
Title or Position: SOLE PROPRIETOR
Credential: DO
Phone: 207-985-8998