Healthcare Provider Details

I. General information

NPI: 1023983889
Provider Name (Legal Business Name): MAEVE GRACE DONNELLY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2025
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 CONGRESS ST STE 309
PORTLAND ME
04101-5354
US

IV. Provider business mailing address

69 MERRILL ST APT 3
PORTLAND ME
04101-5314
US

V. Phone/Fax

Practice location:
  • Phone: 207-615-5213
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberXL8356
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberXL8356
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: