Provider Demographics
NPI:1538319744
Name:CONNECTIONS FOR KIDS
Entity Type:Organization
Organization Name:CONNECTIONS FOR KIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GENEVIEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:207-854-1030
Mailing Address - Street 1:100 GANNETT DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-5900
Mailing Address - Country:US
Mailing Address - Phone:207-854-1030
Mailing Address - Fax:207-854-1001
Practice Address - Street 1:100 GANNETT DR
Practice Address - Street 2:SUITE A
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-5900
Practice Address - Country:US
Practice Address - Phone:207-854-1030
Practice Address - Fax:207-854-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME559381104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME128860004Medicaid
ME432955600Medicaid
ME433455400Medicaid
ME433457000Medicaid
ME432955600OtherMEDICAID FAMILY BRIDGE PROGRAM