Healthcare Provider Details

I. General information

NPI: 1306089917
Provider Name (Legal Business Name): SPURWINK SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2009
Last Update Date: 04/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

587 OCEAN AVE
PORTLAND ME
04103-2701
US

IV. Provider business mailing address

899 RIVERSIDE ST
PORTLAND ME
04103-1070
US

V. Phone/Fax

Practice location:
  • Phone: 207-871-1582
  • Fax: 207-871-9276
Mailing address:
  • Phone: 207-871-1200
  • Fax: 207-871-1232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number502759
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number229881
License Number StateME

VIII. Authorized Official

Name: MS. DAWN STILES
Title or Position: PRESIDENT
Credential: LCSW
Phone: 207-871-1200