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General NPI Number Information
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NPI Number | 1912860487
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Entity Type | Organization
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Legal Business Name | KATAHDIN BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 12/03/2025
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 215 EDENFIELD DR
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City | HERMON
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State | ME
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Zip | 04401-0277
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Country | US
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Telephone | 207-615-9797
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Fax |
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Provider Business Mailing Address
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Address Line | 215 EDENFIELD DR
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City | HERMON
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State | ME
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Zip | 04401-0277
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Country | US
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Telephone | 207-615-9797
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | JASON DOBROVONLY
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Credential | PMHNP
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Telephone | 207-615-9797
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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