Healthcare Provider Details

I. General information

NPI: 1922978790
Provider Name (Legal Business Name): BREEZY ACRES BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2025
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 BREEZY ACRES
MOUNT VERNON ME
04352-3534
US

IV. Provider business mailing address

29 BREEZY ACRES
MOUNT VERNON ME
04352-3534
US

V. Phone/Fax

Practice location:
  • Phone: 207-994-7146
  • Fax:
Mailing address:
  • Phone: 207-994-7146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SHANNON LEIGHANNE COOPER
Title or Position: CLINICAL DIRECTOR
Credential: LCSW
Phone: 207-994-7146