Provider Demographics
NPI:1699400770
Name:GRIGAS, JOHN (CADC, MHRT/C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:GRIGAS
Suffix:
Gender:M
Credentials:CADC, MHRT/C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 CUMBERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2823
Mailing Address - Country:US
Mailing Address - Phone:207-871-7431
Mailing Address - Fax:
Practice Address - Street 1:420 CUMBERLAND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2823
Practice Address - Country:US
Practice Address - Phone:207-871-7431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME36536106S00000X
MECAC7941101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician