Healthcare Provider Details

I. General information

NPI: 1396051959
Provider Name (Legal Business Name): BECKY-JO ANN CUMMINGS MHRT-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2010
Last Update Date: 08/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

273 HAMMOND ST
BANGOR ME
04401-4610
US

IV. Provider business mailing address

59 FOTHINGGILL RD
GREENBUSH ME
04418-3344
US

V. Phone/Fax

Practice location:
  • Phone: 207-217-6710
  • Fax: 207-217-6712
Mailing address:
  • Phone: 207-659-5277
  • Fax: 207-217-6712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberMHRT-C
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: