Healthcare Provider Details

I. General information

NPI: 1689430415
Provider Name (Legal Business Name): SNOW MOON THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2024
Last Update Date: 06/12/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 PORT ROAD SUITE 16 MAILBOX
KENNEBUNK ME
04043-1325
US

IV. Provider business mailing address

369 MAIN ST APT C
SOUTH BERWICK ME
03908-1325
US

V. Phone/Fax

Practice location:
  • Phone: 207-558-2308
  • Fax:
Mailing address:
  • Phone: 618-340-8141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MADELYN ALEXANDRA SAUGET
Title or Position: OWNER
Credential: LCSW
Phone: 618-340-8141