Healthcare Provider Details

I. General information

NPI: 1760637557
Provider Name (Legal Business Name): JONATHAN BERUBE LMFT, CCS, SAP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2008
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

469 MAIN ST STE 101
SPRINGVALE ME
04083-1870
US

IV. Provider business mailing address

469 MAIN ST STE 101
SPRINGVALE ME
04083-1870
US

V. Phone/Fax

Practice location:
  • Phone: 207-651-1287
  • Fax: 207-636-8010
Mailing address:
  • Phone: 207-651-1287
  • Fax: 207-636-8010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberMF4338
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMF4338
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: