Healthcare Provider Details

I. General information

NPI: 1891279238
Provider Name (Legal Business Name): MARIE ANN HAYWOOD CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2018
Last Update Date: 09/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 AIRPORT RD
WATERVILLE ME
04901-4524
US

IV. Provider business mailing address

40 AIRPORT RD
WATERVILLE ME
04901-4524
US

V. Phone/Fax

Practice location:
  • Phone: 207-872-7272
  • Fax: 207-872-0639
Mailing address:
  • Phone: 207-872-7272
  • Fax: 207-872-0639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCAC4699
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: