Healthcare Provider Details

I. General information

NPI: 1437384054
Provider Name (Legal Business Name): MAINE VOCATIONAL ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2009
Last Update Date: 06/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 OXFORD ST SUITE 25A
PORTLAND ME
04101-3190
US

IV. Provider business mailing address

PO BOX 5641
AUGUSTA ME
04332-5641
US

V. Phone/Fax

Practice location:
  • Phone: 207-774-4248
  • Fax:
Mailing address:
  • Phone: 207-774-4248
  • Fax: 207-596-2476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: BETTY JONES
Title or Position: OWNER/TREASURER
Credential:
Phone: 207-623-1898