MEDICARE: BEHAVIORAL HEALTH RESOURCES INC.

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	103TC0700X	Clinical Psychologist
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP081017	ME

General Provider Information

NPI Number	:	1861464380
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEHAVIORAL HEALTH RESOURCES INC.

Provider Business Mailing Address
First Line	:	962 SHORE RD
Second Line	:
City	:	CAPE ELIZABETH
State	:	ME
Zip	:	04107
Country	:	US
Telephone Number	:	207-799-9006
Fax Number	:	207-767-6595

Provider Business Practice Location Address
First Line	:	1000 SHORE RD
Second Line	:	BLDG #326
City	:	CAPE ELIZABETH
State	:	ME
Zip	:	04107
Country	:	US
Telephone Number	:	207-799-9006
Fax Number	:	207-767-6595

Authorized Official
Title or Position	:	CREDENTIALING REP
Name	:	JENNIFER S FOURNIER
Credential	:
Telephone Number	:	207-376-5405

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	11/30/2012

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