Healthcare Provider Details

I. General information

NPI: 1255384723
Provider Name (Legal Business Name): SBSC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 06/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 LANCASTER ST
PORTLAND ME
04101-2418
US

IV. Provider business mailing address

246 WALNUT ST
NEWTON MA
02460-1689
US

V. Phone/Fax

Practice location:
  • Phone: 207-772-2133
  • Fax:
Mailing address:
  • Phone: 617-244-3322
  • Fax: 617-244-1827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: NANCY NAGER
Title or Position: PRESIDENT/CEO
Credential:
Phone: 617-244-3322