Provider Demographics
NPI:1003081266
Name:HEALING RELATIONSHIPS
Entity Type:Organization
Organization Name:HEALING RELATIONSHIPS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:HARRISON
Authorized Official - Last Name:KLOCKOW
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:207-729-7710
Mailing Address - Street 1:9 EVERETT ST
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2403
Mailing Address - Country:US
Mailing Address - Phone:207-729-7710
Mailing Address - Fax:207-729-7801
Practice Address - Street 1:9 EVERETT ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2403
Practice Address - Country:US
Practice Address - Phone:207-729-7710
Practice Address - Fax:207-729-7801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEME 1256Medicare PIN