Provider Demographics
NPI:1164047189
Name:NANTUCKET COUNSELING
Entity Type:Organization
Organization Name:NANTUCKET COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERUBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-651-1287
Mailing Address - Street 1:886 MAIN ST STE 305
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073-7009
Mailing Address - Country:US
Mailing Address - Phone:207-651-1287
Mailing Address - Fax:207-636-8010
Practice Address - Street 1:886 MAIN ST STE 305
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-7009
Practice Address - Country:US
Practice Address - Phone:207-651-1287
Practice Address - Fax:207-636-8010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-15
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty