Provider Demographics
NPI:1851897193
Name:JULIE RACINE, INC
Entity Type:Organization
Organization Name:JULIE RACINE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RACINE
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:207-447-1396
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:ME
Mailing Address - Zip Code:04776-0158
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:226 MAIN ST
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:ME
Practice Address - Zip Code:04776-3064
Practice Address - Country:US
Practice Address - Phone:207-365-9932
Practice Address - Fax:207-433-1131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-04
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0801X
ME363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1598964405OtherNPI