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General NPI Number Information
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NPI Number | 1518331032
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Entity Type | Organization
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Legal Business Name | PARTNERSHIP FOR TRAUMA RECOVERY
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Dates
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Enumeration Date | 11/20/2015
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 45 MALLETT DR
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City | FREEPORT
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State | ME
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Zip | 04032-1312
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Country | US
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Telephone | 207-894-8104
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Fax |
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Provider Business Mailing Address
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Address Line | 491 US ROUTE 1 STE 23
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City | FREEPORT
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State | ME
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Zip | 04032-7022
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Country | US
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Telephone | 207-318-8911
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | GRACE WRIGHT
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Credential | LCSW
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Telephone | 207-894-8104
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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