Healthcare Provider Details

I. General information

NPI: 1326286634
Provider Name (Legal Business Name): BAMBI MORGAN DELATTRE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2009
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 WESTERN AVE STE 207
SOUTH PORTLAND ME
04106-2457
US

IV. Provider business mailing address

260 WESTERN AVE STE 207
SOUTH PORTLAND ME
04106-2457
US

V. Phone/Fax

Practice location:
  • Phone: 603-606-9357
  • Fax: 603-217-2075
Mailing address:
  • Phone: 603-606-9357
  • Fax: 603-217-2075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number016001944
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: