Provider Demographics
NPI:1376756361
Name:SMITH, JULIE M,
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:M,
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 AUGUSTA RD
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:ME
Mailing Address - Zip Code:04963-3137
Mailing Address - Country:US
Mailing Address - Phone:207-397-2131
Mailing Address - Fax:
Practice Address - Street 1:802 AUGUSTA RD
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:ME
Practice Address - Zip Code:04963-3137
Practice Address - Country:US
Practice Address - Phone:207-397-2131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEALLS2153320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities