Provider Demographics
NPI:1811226087
Name:MAITRI PSYCHOTHERAPY ASSOCIATES
Entity Type:Organization
Organization Name:MAITRI PSYCHOTHERAPY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:REID
Authorized Official - Middle Name:DALTON
Authorized Official - Last Name:LESNESKI
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:207-363-8300
Mailing Address - Street 1:433 US ROUTE 1
Mailing Address - Street 2:COTTAGE PLACE, SUITE 204
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909-1659
Mailing Address - Country:US
Mailing Address - Phone:207-363-8300
Mailing Address - Fax:207-363-8301
Practice Address - Street 1:433 US ROUTE 1
Practice Address - Street 2:COTTAGE PLACE, SUITE 204
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-1659
Practice Address - Country:US
Practice Address - Phone:207-363-8300
Practice Address - Fax:207-363-8301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC3081101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432296899Medicaid