Healthcare Provider Details

I. General information

NPI: 1750212742
Provider Name (Legal Business Name): JUAN MATEO PMHNP-BC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 ROOSEVELT TRL STE 207
WINDHAM ME
04062-5281
US

IV. Provider business mailing address

401 CUMBERLAND AVE APT 203
PORTLAND ME
04101-2872
US

V. Phone/Fax

Practice location:
  • Phone: 207-200-8487
  • Fax: 207-401-7198
Mailing address:
  • Phone: 207-200-8487
  • Fax: 207-401-7198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: JUAN CARLOS MATEO
Title or Position: PMHNP
Credential: PMHNP-BC/ APRN-NP
Phone: 718-913-8899