Healthcare Provider Details

I. General information

NPI: 1235266602
Provider Name (Legal Business Name): MAINE SPECIAL EDUCATION MENTAL HEALTH COLLABORATIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 PINELAND DR STE 200
NEW GLOUCESTER ME
04260-5111
US

IV. Provider business mailing address

41 PINELAND DR STE 200
NEW GLOUCESTER ME
04260-5111
US

V. Phone/Fax

Practice location:
  • Phone: 207-688-2253
  • Fax: 207-688-4561
Mailing address:
  • Phone: 207-688-2253
  • Fax: 207-688-4561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number394273
License Number StateME

VIII. Authorized Official

Name: MS. LAURI MARCHEWKA
Title or Position: EXECUTIVE DIRECTOR
Credential: L.C.S.W.
Phone: 207-688-2253