Healthcare Provider Details

I. General information

NPI: 1689475832
Provider Name (Legal Business Name): MAIA ADELAIDA CAMPOAMOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 03/24/2025
Certification Date: 03/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 PEAVEY TOWN RD
MONTVILLE ME
04941-4327
US

IV. Provider business mailing address

238 PEAVEY TOWN RD
MONTVILLE ME
04941-4327
US

V. Phone/Fax

Practice location:
  • Phone: 207-323-1084
  • Fax:
Mailing address:
  • Phone: 207-323-1084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: