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General NPI Number Information
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NPI Number | 1033216106
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Entity Type | Organization
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Legal Business Name | INGRAHAM
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 50 MONUMENT SQ
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City | PORTLAND
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State | ME
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Zip | 04101-4039
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Country | US
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Telephone | 207-874-1055
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Fax | 207-774-5901
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Provider Business Mailing Address
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Address Line | PO BOX 1868
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City | PORTLAND
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State | ME
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Zip | 04104-1868
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Country | US
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Telephone | 207-874-1055
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Fax | 207-774-5901
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. JANE MORRISON
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Credential |
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Telephone | 207-874-1055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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