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General NPI Number Information
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NPI Number | 1417225988
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Entity Type | Organization
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Legal Business Name | AQUILA MENTAL HEALTH SERVICES PA SC
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Dates
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Enumeration Date | 12/12/2011
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Last Update Date | 04/30/2012
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Provider Practice Location Address
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Address Line | 175 UNION ST STE C
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City | BANGOR
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State | ME
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Zip | 04401-6100
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Country | US
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Telephone | 207-992-6269
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Fax | 207-433-1032
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Provider Business Mailing Address
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Address Line | 175 UNION ST STE C
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City | BANGOR
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State | ME
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Zip | 04401-6100
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Country | US
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Telephone | 207-992-6269
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Fax | 207-433-1032
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Authorized Official
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Title or Position | OWNER
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Name | NAOMI JEAN BROWN
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Credential | PMHNP, BC
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Telephone | 207-992-6269
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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 | 81132
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License Number State | ME
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