Provider Demographics
NPI:1033403860
Name:INSIGHTS FAMILY THERAPY
Entity Type:Organization
Organization Name:INSIGHTS FAMILY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:207-942-5055
Mailing Address - Street 1:PO BOX 623
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-0623
Mailing Address - Country:US
Mailing Address - Phone:207-942-5055
Mailing Address - Fax:207-942-7013
Practice Address - Street 1:607 HUDSON RD
Practice Address - Street 2:
Practice Address - City:GLENBURN
Practice Address - State:ME
Practice Address - Zip Code:04401-1406
Practice Address - Country:US
Practice Address - Phone:207-944-3804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME530640251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME245530099Medicaid
ME245530099Medicaid