Healthcare Provider Details

I. General information

NPI: 1922170901
Provider Name (Legal Business Name): EASTER SEALS MAINE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 11/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 ATLANTIC PL
SOUTH PORTLAND ME
04106-2316
US

IV. Provider business mailing address

555 AUBURN ST
MANCHESTER NH
03103-4803
US

V. Phone/Fax

Practice location:
  • Phone: 207-560-2894
  • Fax: 207-773-1139
Mailing address:
  • Phone: 603-623-8863
  • Fax: 603-622-8101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ELIN TREANOR
Title or Position: CFO
Credential:
Phone: 603-621-3462