Provider Demographics
NPI:1346543634
Name:SOTERIA MENTAL HEALTH
Entity Type:Organization
Organization Name:SOTERIA MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:HENNEBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:207-907-4311
Mailing Address - Street 1:444 STILLWATER AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3521
Mailing Address - Country:US
Mailing Address - Phone:207-907-4311
Mailing Address - Fax:207-907-4322
Practice Address - Street 1:444 STILLWATER AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3521
Practice Address - Country:US
Practice Address - Phone:207-907-4311
Practice Address - Fax:207-907-4322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty