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General NPI Number Information
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NPI Number | 1538319744
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Entity Type | Organization
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Legal Business Name | CONNECTIONS FOR KIDS
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Dates
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Enumeration Date | 09/24/2008
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Last Update Date | 01/26/2017
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Provider Practice Location Address
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Address Line | 100 GANNETT DR SUITE A
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-5900
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Country | US
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Telephone | 207-854-1030
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Fax | 207-854-1001
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Provider Business Mailing Address
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Address Line | 100 GANNETT DR SUITE A
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-5900
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Country | US
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Telephone | 207-854-1030
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Fax | 207-854-1001
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | GENEVIEVE GARDNER
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Credential | LCSW
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Telephone | 207-854-1030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 559381
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License Number State | ME
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