Provider Demographics
NPI:1437370277
Name:CARE DEVELOPMENT OF MAINE
Entity Type:Organization
Organization Name:CARE DEVELOPMENT OF MAINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:207-941-2824
Mailing Address - Street 1:PO BOX 923
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-0923
Mailing Address - Country:US
Mailing Address - Phone:207-941-2824
Mailing Address - Fax:207-941-2845
Practice Address - Street 1:51 4TH ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6140
Practice Address - Country:US
Practice Address - Phone:207-941-2824
Practice Address - Fax:207-941-2845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC9998251S00000X, 320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251S00000XAgenciesCommunity/Behavioral Health
Not Answered320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness