MEDICARE: GREGORY STINE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	CC2274	ME

General Provider Information

NPI Number	:	1457438509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY STINE

Provider Business Mailing Address
First Line	:	P.O. BOX 526
Second Line	:
City	:	ROCKLAND
State	:	ME
Zip	:	04841-2739
Country	:	US
Telephone Number	:	207-701-4477
Fax Number	:	207-701-4486

Provider Business Practice Location Address
First Line	:	12 UNION ST
Second Line	:
City	:	ROCKLAND
State	:	ME
Zip	:	04841-2978
Country	:	US
Telephone Number	:	207-701-4477
Fax Number	:	207-701-4486

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	02/28/2008

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Directions to “ GREGORY STINE ” Practice Location

Language	Start Address	Practice Location

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