Healthcare Provider Details

I. General information

NPI: 1467174185
Provider Name (Legal Business Name): ELM CITY ADDICTION AND PSYHCIATRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 MAIN ST STE 202
WATERVILLE ME
04901-6672
US

IV. Provider business mailing address

179 MAIN ST STE 202
WATERVILLE ME
04901-6672
US

V. Phone/Fax

Practice location:
  • Phone: 207-616-0896
  • Fax: 207-616-3006
Mailing address:
  • Phone: 207-616-0896
  • Fax: 207-616-3006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. JANET ALLEYNE ZALANSKAS
Title or Position: OWNER
Credential: PMH NP
Phone: 207-616-0896