Provider Demographics
NPI:1134370570
Name:MARIANNE C. BERUBE COUNSELING
Entity type:Organization
Organization Name:MARIANNE C. BERUBE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:C
Authorized Official - Last Name:BERUBE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:207-432-2296
Mailing Address - Street 1:58 PORTLAND RD
Mailing Address - Street 2:P.O. BOX 1084
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-6656
Mailing Address - Country:US
Mailing Address - Phone:207-432-2296
Mailing Address - Fax:207-799-9353
Practice Address - Street 1:58 PORTLAND RD
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-6656
Practice Address - Country:US
Practice Address - Phone:207-432-2296
Practice Address - Fax:207-799-9353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-03
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC11467251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME000602101Medicare PIN