Provider Demographics
NPI:1275892689
Name:AND BREATHE,LLC
Entity Type:Organization
Organization Name:AND BREATHE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNYN
Authorized Official - Middle Name:
Authorized Official - Last Name:VICENTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-274-9639
Mailing Address - Street 1:95 PARKER ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-4033
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:47 PORTLAND ST
Practice Address - Street 2:2ND FL.
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-3188
Practice Address - Country:US
Practice Address - Phone:207-274-9639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-07
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1962761361Medicaid
ME1962761361Medicaid