Healthcare Provider Details

I. General information

NPI: 1164047189
Provider Name (Legal Business Name): NANTUCKET COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2020
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 Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JONATHAN BERUBE
Title or Position: CEO
Credential: LMFT, CCS, SAP
Phone: 207-651-1287