Provider Demographics
NPI:1801202999
Name:SHORELINE NEUROBEHAVIORAL SERVICES, LLC
Entity Type:Organization
Organization Name:SHORELINE NEUROBEHAVIORAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:SNOW GIRARD
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:207-934-5858
Mailing Address - Street 1:45 CUNNINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032-6312
Mailing Address - Country:US
Mailing Address - Phone:207-934-5858
Mailing Address - Fax:
Practice Address - Street 1:45 CUNNINGHAM RD
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:ME
Practice Address - Zip Code:04032-6312
Practice Address - Country:US
Practice Address - Phone:207-934-5858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty