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General NPI Number Information
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NPI Number | 1538769203
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Entity Type | Organization
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Legal Business Name | FERN RIVER PSYCHIATRY, LLC
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Dates
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Enumeration Date | 10/30/2020
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Last Update Date | 10/04/2021
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Provider Practice Location Address
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Address Line | 50 MARKET STREET STE 1A , #320
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City | S. PORTLAND
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State | ME
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Zip | 04106-3646
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Country | US
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Telephone | 207-956-0050
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Fax | 833-606-1216
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Provider Business Mailing Address
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Address Line | 50 MARKET STREET STE 1A, # 320
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City | S. PORTLAND
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State | ME
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Zip | 04106-3646
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Country | US
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Telephone | 207-956-0050
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Fax | 833-606-1216
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | ABIGAIL KEENAN
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Credential | DO
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Telephone | 207-956-0050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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