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General NPI Number Information
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NPI Number | 1003753278
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Entity Type | Organization
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Legal Business Name | COASTAL COLLABORATIVE PSYCHIATRY, LLC
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Dates
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Enumeration Date | 05/04/2026
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Last Update Date | 05/04/2026
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Provider Practice Location Address
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Address Line | 15 PLEASANT HILL RD
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City | SCARBOROUGH
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State | ME
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Zip | 04074-9688
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Country | US
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Telephone | 207-813-7938
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Fax | 207-656-6243
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Provider Business Mailing Address
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Address Line | 15 PLEASANT HILL RD
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City | SCARBOROUGH
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State | ME
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Zip | 04074-9688
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Country | US
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Telephone | 207-813-7938
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Fax | 207-656-6243
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Authorized Official
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Title or Position | OWNER, APRN
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Name | SHAHEEN GANEM
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Credential | APRN, PMHNP-BC
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Telephone | 272-268-5794
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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