Provider Demographics
NPI:1225521222
Name:HOLISTIC PSYCHIATRY LLC
Entity Type:Organization
Organization Name:HOLISTIC PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:A
Authorized Official - Last Name:AMARENDRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-299-1997
Mailing Address - Street 1:12 ACME RD STE 102
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1546
Mailing Address - Country:US
Mailing Address - Phone:207-299-1997
Mailing Address - Fax:207-387-2828
Practice Address - Street 1:12 ACME RD STE 102
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-1546
Practice Address - Country:US
Practice Address - Phone:207-299-1997
Practice Address - Fax:207-387-2828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-13
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty