=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467200899
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | R.I.S.E. INTEGRATED MENTAL HEALTH PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2024
-----------------------------------------------------
Last Update Date | 02/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4 MARKET PLACE DR UNIT 1-2
-----------------------------------------------------
City | YORK
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 03909-1698
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-630-2922
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 APPLE TREE CT
-----------------------------------------------------
City | YORK
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 03909-5415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-747-9581
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER/OWNER
-----------------------------------------------------
Name | AMANDA SEDGWICK
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 207-747-9581
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------