MEDICARE: MEDOPTIONS OF MAINE, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103TC0700X	Clinical Psychologist
2	1041C0700X	Clinical Social Worker
3	363L00000X	Nurse Practitioner
4	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1942743679
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDOPTIONS OF MAINE, LLC

Provider Business Mailing Address
First Line	:	PO BOX 1595
Second Line	:
City	:	MIDDLETOWN
State	:	CT
Zip	:	06457-8095
Country	:	US
Telephone Number	:	860-788-6404
Fax Number	:	860-829-0495

Provider Business Practice Location Address
First Line	:	45 MEMORIAL CIR
Second Line	:
City	:	AUGUSTA
State	:	ME
Zip	:	04330-6400
Country	:	US
Telephone Number	:	860-788-6404
Fax Number	:	860-829-0495

Authorized Official
Title or Position	:	CREDENTIALING & ENROLLMENT MANAGER
Name	:	ANDREA GODFREY
Credential	:
Telephone Number	:	860-398-6441

Provider Enumeration Date	:	11/29/2016
Last Update Date	:	05/05/2025

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Directions to “MEDOPTIONS OF MAINE, LLC ” Practice Location

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