Provider Demographics
NPI:1558634246
Name:NANCY MAIELLO LICSW LLC
Entity Type:Organization
Organization Name:NANCY MAIELLO LICSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:207-752-0731
Mailing Address - Street 1:90 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2586
Mailing Address - Country:US
Mailing Address - Phone:207-752-0731
Mailing Address - Fax:
Practice Address - Street 1:90 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2586
Practice Address - Country:US
Practice Address - Phone:207-752-0731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-12
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH653251S00000X
261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No251S00000XAgenciesCommunity/Behavioral Health