Healthcare Provider Details

I. General information

NPI: 1366953424
Provider Name (Legal Business Name): YOUNG MEN'S CHRISTIAN ASSOCIATION OF SOUTHERN MAINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2017
Last Update Date: 10/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 FOREST AVE
PORTLAND ME
04101-2813
US

IV. Provider business mailing address

70 FOREST AVE
PORTLAND ME
04101-2813
US

V. Phone/Fax

Practice location:
  • Phone: 207-874-1111
  • Fax: 207-842-2966
Mailing address:
  • Phone: 207-874-1111
  • Fax: 207-842-2966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: HELEN BRENA
Title or Position: CEO
Credential:
Phone: 207-874-1111