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General NPI Number Information
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NPI Number | 1689755530
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Entity Type | Organization
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Legal Business Name | BROADLEAF BEHAVIORAL HEALTH PC
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 04/13/2010
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Provider Practice Location Address
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Address Line | 9 OLD SAWMILL LN
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City | ARUNDEL
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State | ME
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Zip | 04046-8164
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Country | US
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Telephone | 207-985-8998
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Fax | 207-985-1281
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Provider Business Mailing Address
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Address Line | PO BOX 810
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City | WESTBROOK
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State | ME
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Zip | 04098-0810
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Country | US
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Telephone | 800-595-0033
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Fax | 207-839-3190
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DR. DAVID P JONES
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Credential | DO
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Telephone | 207-985-8998
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number | ME1558
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License Number State | ME
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