MEDICARE: WITHIN REACH LLC

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	:	1700334307
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WITHIN REACH LLC

Provider Business Mailing Address
First Line	:	169 OCEAN ST STE 201
Second Line	:
City	:	SOUTH PORTLAND
State	:	ME
Zip	:	04106-3636
Country	:	US
Telephone Number	:	207-536-4860
Fax Number	:	207-536-4861

Provider Business Practice Location Address
First Line	:	169 OCEAN ST STE 201
Second Line	:
City	:	SOUTH PORTLAND
State	:	ME
Zip	:	04106-3636
Country	:	US
Telephone Number	:	207-536-4860
Fax Number	:	207-536-4861

Authorized Official
Title or Position	:	CEO/CLINICAL DIRECTOR
Name	:	LAUREN CHRISTINE KENNETT
Credential	:	MS, BSN, RN
Telephone Number	:	207-536-4860

Provider Enumeration Date	:	09/13/2016
Last Update Date	:	09/13/2016

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Directions to “WITHIN REACH LLC ” Practice Location

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