Provider Demographics
NPI:1164657045
Name:SOOHEY, JOSEPH
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:SOOHEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 BELFAST AUGUSTA RD W
Mailing Address - Street 2:
Mailing Address - City:SEARSMONT
Mailing Address - State:ME
Mailing Address - Zip Code:04973-3749
Mailing Address - Country:US
Mailing Address - Phone:207-342-5267
Mailing Address - Fax:
Practice Address - Street 1:244 BELFAST AUGUSTA RD W
Practice Address - Street 2:
Practice Address - City:SEARSMONT
Practice Address - State:ME
Practice Address - Zip Code:04973-3749
Practice Address - Country:US
Practice Address - Phone:207-342-5267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-21
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1D202480000Medicare PIN