Healthcare Provider Details

I. General information

NPI: 1285778548
Provider Name (Legal Business Name): GEOFFRY W PHILLIPS MCENANY PHD, APRN, BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: GEOFFRY W MCENANY PHD, APRN, BC

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 06/09/2023
Certification Date: 06/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 SPRUCE AVE.
PEAKS ISLAND ME
04108
US

IV. Provider business mailing address

48 SPRUCE AVE.
PEAKS ISLAND ME
04108
US

V. Phone/Fax

Practice location:
  • Phone: 857-290-8197
  • Fax: 866-323-2249
Mailing address:
  • Phone: 617-696-7925
  • Fax: 617-322-1084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number239814
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: