Healthcare Provider Details

I. General information

NPI: 1487524047
Provider Name (Legal Business Name): ALEXA DARE MHRTC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 11/10/2025
Certification Date: 11/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 MAIN ST
LINCOLN ME
04457-1253
US

IV. Provider business mailing address

299 PARK ST
SPRINGFIELD ME
04487-4515
US

V. Phone/Fax

Practice location:
  • Phone: 207-521-8911
  • Fax: 207-521-8555
Mailing address:
  • Phone: 207-521-8911
  • Fax: 207-521-8555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number41396
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: