Healthcare Provider Details

I. General information

NPI: 1912051673
Provider Name (Legal Business Name): CHILD DEVELOPMENT SERVICES-HANCOCK COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 BANGOR RD SUITE A
ELLSWORTH ME
04605-3258
US

IV. Provider business mailing address

190 BANGOR RD SUITE A
ELLSWORTH ME
04605-3258
US

V. Phone/Fax

Practice location:
  • Phone: 207-667-7108
  • Fax: 207-664-0461
Mailing address:
  • Phone: 207-667-7108
  • Fax: 207-664-0461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberME260700
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: KELLI POLLACK
Title or Position: FINANCE MANAGER
Credential:
Phone: 207-667-7108