Provider Demographics
NPI:1437448826
Name:CATHOLIC CHARITIES OF MAINE
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES OF MAINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:KARL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:CLINICAL COUNSELOR
Authorized Official - Phone:207-871-7431
Mailing Address - Street 1:PO BOX 797
Mailing Address - Street 2:66 STATE ST
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04104
Mailing Address - Country:US
Mailing Address - Phone:207-871-7431
Mailing Address - Fax:207-871-7457
Practice Address - Street 1:66 STATE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04104
Practice Address - Country:US
Practice Address - Phone:207-871-7431
Practice Address - Fax:207-871-7457
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLIC CHARITIES OF MAINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC1955104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME100200203Medicaid