MEDICARE: MAINE CENTER ON DEAFNESS

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1558632984
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAINE CENTER ON DEAFNESS

Provider Business Mailing Address
First Line	:	68 BISHOP ST
Second Line	:	SUITE 3
City	:	PORTLAND
State	:	ME
Zip	:	04103-2681
Country	:	US
Telephone Number	:	207-797-7656
Fax Number	:	207-797-9791

Provider Business Practice Location Address
First Line	:	68 BISHOP ST
Second Line	:	SUITE 3
City	:	PORTLAND
State	:	ME
Zip	:	04103-2681
Country	:	US
Telephone Number	:	207-797-7656
Fax Number	:	207-797-9791

Authorized Official
Title or Position	:	SOCIAL WORKER
Name	:	MS. JENNIFER L MCCANN
Credential	:	LCSW
Telephone Number	:	207-797-7656

Provider Enumeration Date	:	01/17/2012
Last Update Date	:	01/17/2012

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Directions to “MAINE CENTER ON DEAFNESS ” Practice Location

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