Provider Demographics
NPI:1134426323
Name:THE AWARE CENTER FOR EARLY INTERVENTION, LLC
Entity type:Organization
Organization Name:THE AWARE CENTER FOR EARLY INTERVENTION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:POLLARD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:207-208-8301
Mailing Address - Street 1:61 MAIN ST
Mailing Address - Street 2:SUITE 53
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6397
Mailing Address - Country:US
Mailing Address - Phone:207-208-8301
Mailing Address - Fax:877-320-4344
Practice Address - Street 1:61 MAIN ST
Practice Address - Street 2:SUITE 53
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6397
Practice Address - Country:US
Practice Address - Phone:207-208-8301
Practice Address - Fax:877-320-4344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC109271041C0700X
MEAP081171363LP0808X
MEPS1219103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty