Healthcare Provider Details

I. General information

NPI: 1700996063
Provider Name (Legal Business Name): UMBRELLA MENTAL HEALTH SERVICES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 03/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 BISCAY RD
DAMARISCOTTA ME
04543-4614
US

IV. Provider business mailing address

PO BOX 157
NOBLEBORO ME
04555-0157
US

V. Phone/Fax

Practice location:
  • Phone: 207-563-3022
  • Fax: 207-563-3061
Mailing address:
  • Phone: 207-563-3022
  • Fax: 207-563-3061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number486719
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License Number486719
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number486719
License Number StateME

VIII. Authorized Official

Name: MRS. MARJORIE ELAINE AVERILL
Title or Position: PRESIDENT/OWNER
Credential: LCSW
Phone: 207-563-3022