Healthcare Provider Details

I. General information

NPI: 1083480487
Provider Name (Legal Business Name): ABLE OAK MENTAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2023
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

469 MAIN ST STE 201
SPRINGVALE ME
04083-1870
US

IV. Provider business mailing address

8 HOWARD ST
SPRINGVALE ME
04083-1919
US

V. Phone/Fax

Practice location:
  • Phone: 207-850-1082
  • Fax: 888-681-5805
Mailing address:
  • Phone: 518-368-5455
  • Fax: 888-681-5805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MRS. JILLIAN MARIE DERUSCIO BELLEARD
Title or Position: OWNER
Credential: LCPC
Phone: 518-368-5455