=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467174185
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELM CITY ADDICTION AND PSYHCIATRY PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2022
-----------------------------------------------------
Last Update Date | 09/19/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 179 MAIN ST STE 202
-----------------------------------------------------
City | WATERVILLE
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04901-6672
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-616-0896
-----------------------------------------------------
Fax | 207-616-3006
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 179 MAIN ST STE 202
-----------------------------------------------------
City | WATERVILLE
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04901-6672
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-616-0896
-----------------------------------------------------
Fax | 207-616-3006
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. JANET ALLEYNE ZALANSKAS
-----------------------------------------------------
Credential | PMH NP
-----------------------------------------------------
Telephone | 207-616-0896
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------