Provider Demographics
NPI:1982825857
Name:CITY OF WESTBROOK
Entity Type:Organization
Organization Name:CITY OF WESTBROOK
Other - Org Name:WESTBROOK SCHOOL DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRITY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:207-854-0850
Mailing Address - Street 1:117 STROUDWATER ST
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-4045
Mailing Address - Country:US
Mailing Address - Phone:207-854-0850
Mailing Address - Fax:207-854-0851
Practice Address - Street 1:117 STROUDWATER ST
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-4045
Practice Address - Country:US
Practice Address - Phone:207-854-0850
Practice Address - Fax:207-854-0851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME136090100Medicaid