Healthcare Provider Details

I. General information

NPI: 1184275919
Provider Name (Legal Business Name): MAEVE CORISH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2019
Last Update Date: 09/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 SOKOKIS TRL
EAST WATERBORO ME
04030-5411
US

IV. Provider business mailing address

50 ADAMS ST APT 1
BIDDEFORD ME
04005-2995
US

V. Phone/Fax

Practice location:
  • Phone: 267-530-0830
  • Fax:
Mailing address:
  • Phone: 267-530-0830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberST3003
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: