Healthcare Provider Details

I. General information

NPI: 1780785337
Provider Name (Legal Business Name): MAINE GENERAL COMMUNITY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 09/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 HIGHWOOD ST
WATERVILLE ME
04901-5740
US

IV. Provider business mailing address

8 HIGHWOOD ST
WATERVILLE ME
04901-5740
US

V. Phone/Fax

Practice location:
  • Phone: 207-861-3488
  • Fax: 207-861-3470
Mailing address:
  • Phone: 207-861-3488
  • Fax: 207-861-3470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number230503
License Number StateME

VIII. Authorized Official

Name: ANGELA VICTORY
Title or Position: DIRECTOR OF REVENUE CYCLE
Credential:
Phone: 207-861-3488