Provider Demographics
NPI:1407192958
Name:OCEAN WAY MENTAL HEALTH AGENCY INC
Entity Type:Organization
Organization Name:OCEAN WAY MENTAL HEALTH AGENCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:TARDIFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-354-8184
Mailing Address - Street 1:78 BEECHWOOD ST
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:ME
Mailing Address - Zip Code:04861-3621
Mailing Address - Country:US
Mailing Address - Phone:207-354-8184
Mailing Address - Fax:207-354-0487
Practice Address - Street 1:78 BEECHWOOD ST
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:ME
Practice Address - Zip Code:04861-3621
Practice Address - Country:US
Practice Address - Phone:207-354-8184
Practice Address - Fax:207-354-0487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-02
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME590803251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management