Provider Demographics
NPI:1619682366
Name:PATRONUS LLC
Entity Type:Organization
Organization Name:PATRONUS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:SANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:207-352-5011
Mailing Address - Street 1:701 US ROUTE 1 STE 2A
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-7006
Mailing Address - Country:US
Mailing Address - Phone:207-352-5011
Mailing Address - Fax:207-352-5013
Practice Address - Street 1:701 US ROUTE 1 STE 2A
Practice Address - Street 2:
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-7006
Practice Address - Country:US
Practice Address - Phone:207-352-5011
Practice Address - Fax:207-352-5013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty