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General NPI Number Information
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NPI Number | 1861934622
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Entity Type | Organization
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Legal Business Name | REDEFINING THERAPY LLC
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Dates
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Enumeration Date | 11/10/2016
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Last Update Date | 11/10/2016
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Provider Practice Location Address
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Address Line | 222 SAINT JOHN ST SUITE 231
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City | PORTLAND
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State | ME
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Zip | 04102-3000
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Country | US
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Telephone | 207-232-3092
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Fax | 207-613-9500
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Provider Business Mailing Address
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Address Line | 222 SAINT JOHN ST SUITE 231
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City | PORTLAND
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State | ME
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Zip | 04102-3000
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Country | US
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Telephone | 207-232-3092
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Fax | 207-613-9500
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Authorized Official
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Title or Position | OWNER
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Name | KEITA WHITTEN
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Credential | LCSW
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Telephone | 207-232-3092
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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 | LC14128
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License Number State | ME
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