Healthcare Provider Details

I. General information

NPI: 1932020948
Provider Name (Legal Business Name): SOURCE INTEGRATIVE PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 RAILROAD SQ STE 1
WATERVILLE ME
04901-6139
US

IV. Provider business mailing address

13 RAILROAD SQ STE 1
WATERVILLE ME
04901-6139
US

V. Phone/Fax

Practice location:
  • Phone: 207-204-7064
  • Fax: 949-989-7341
Mailing address:
  • Phone: 207-204-7064
  • Fax: 949-989-7341

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: SARA ADAIR MULVEY
Title or Position: OWNER/PROVIDER
Credential: PMHNP-BC
Phone: 207-204-7064