Healthcare Provider Details

I. General information

NPI: 1700699675
Provider Name (Legal Business Name): FIDDLEHEAD FAMILY THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

844 STEVENS AVE STE 33
PORTLAND ME
04103-2676
US

IV. Provider business mailing address

89 CLAPBOARD RD
PORTLAND ME
04103-2246
US

V. Phone/Fax

Practice location:
  • Phone: 207-367-1414
  • Fax:
Mailing address:
  • Phone: 303-946-7699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: ELISE OVERCASH
Title or Position: THERAPIST, OWNER
Credential: MA, LMFT
Phone: 207-367-1414