Healthcare Provider Details

I. General information

NPI: 1851628804
Provider Name (Legal Business Name): BREAK OF DAY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2009
Last Update Date: 11/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 S STRONG RD #4
FARMINGTON ME
04938-5112
US

IV. Provider business mailing address

462 S STRONG RD # 4
FARMINGTON ME
04938-5112
US

V. Phone/Fax

Practice location:
  • Phone: 207-860-8670
  • Fax:
Mailing address:
  • Phone: 207-860-8670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberXL3016
License Number StateME

VIII. Authorized Official

Name: MS. JOANNE THERESA CARTER
Title or Position: CLINICIAN
Credential: LCPC-C
Phone: 207-860-8670