Healthcare Provider Details

I. General information

NPI: 1518331032
Provider Name (Legal Business Name): PARTNERSHIP FOR TRAUMA RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2015
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 MALLETT DR
FREEPORT ME
04032-1312
US

IV. Provider business mailing address

491 US ROUTE 1 STE 23
FREEPORT ME
04032-7022
US

V. Phone/Fax

Practice location:
  • Phone: 207-894-8104
  • Fax:
Mailing address:
  • Phone: 207-318-8911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: GRACE WRIGHT
Title or Position: PARTNER
Credential: LCSW
Phone: 207-894-8104