Healthcare Provider Details

I. General information

NPI: 1073431177
Provider Name (Legal Business Name): UNITED CEREBRAL PALSY OF NORTHEASTERN MAINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

283 DIRIGO DR
BREWER ME
04412-1665
US

IV. Provider business mailing address

700 MOUNT HOPE AVE STE 320
BANGOR ME
04401-5680
US

V. Phone/Fax

Practice location:
  • Phone: 207-941-2952
  • Fax: 207-941-2955
Mailing address:
  • Phone: 207-941-2952
  • Fax: 207-941-2955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: SCOTT TASH
Title or Position: CEO
Credential:
Phone: 207-941-2952