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General NPI Number Information
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NPI Number | 1891833760
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Entity Type | Organization
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Legal Business Name | ART OF AWARENESS, INC.
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 05/17/2012
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Provider Practice Location Address
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Address Line | 813 BROADWAY
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-2708
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Country | US
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Telephone | 207-799-1331
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Fax | 207-799-1350
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Provider Business Mailing Address
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Address Line | 813 BROADWAY
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-2708
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Country | US
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Telephone | 207-799-1331
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Fax | 207-799-1350
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Authorized Official
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Title or Position | DIRECTOR
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Name | IDA M. O'DONNELL
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Credential | L.C.S.W.
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Telephone | 207-799-1331
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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 | LC4676
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License Number State | ME
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