Provider Demographics
NPI:1003059189
Name:MURCHISON, MAUREEN N (CBIS)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:N
Last Name:MURCHISON
Suffix:
Gender:F
Credentials:CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 BENNETT DR STE 210
Mailing Address - Street 2:
Mailing Address - City:CARIBOU
Mailing Address - State:ME
Mailing Address - Zip Code:04736-2049
Mailing Address - Country:US
Mailing Address - Phone:207-498-3820
Mailing Address - Fax:207-498-3591
Practice Address - Street 1:159 BENNETT DR STE 201
Practice Address - Street 2:
Practice Address - City:CARIBOU
Practice Address - State:ME
Practice Address - Zip Code:04736
Practice Address - Country:US
Practice Address - Phone:207-498-3820
Practice Address - Fax:207-498-3591
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225C00000X
ME2355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432726599Medicaid