Provider Demographics
NPI:1235266602
Name:MAINE SPECIAL EDUCATION MENTAL HEALTH COLLABORATIVE
Entity Type:Organization
Organization Name:MAINE SPECIAL EDUCATION MENTAL HEALTH COLLABORATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURI
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCHEWKA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:207-688-2253
Mailing Address - Street 1:41 PINELAND DR STE 200
Mailing Address - Street 2:
Mailing Address - City:NEW GLOUCESTER
Mailing Address - State:ME
Mailing Address - Zip Code:04260-5111
Mailing Address - Country:US
Mailing Address - Phone:207-688-2253
Mailing Address - Fax:207-688-4561
Practice Address - Street 1:41 PINELAND DR STE 200
Practice Address - Street 2:
Practice Address - City:NEW GLOUCESTER
Practice Address - State:ME
Practice Address - Zip Code:04260-5111
Practice Address - Country:US
Practice Address - Phone:207-688-2253
Practice Address - Fax:207-688-4561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME394273251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services