Provider Demographics
NPI:1245435171
Name:PSYCHIATRIC ASSOCIATES
Entity type:Organization
Organization Name:PSYCHIATRIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SLAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW DCSW BCD
Authorized Official - Phone:207-772-7265
Mailing Address - Street 1:80 EXCHANGE ST
Mailing Address - Street 2:SUITE 28
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-5035
Mailing Address - Country:US
Mailing Address - Phone:207-772-7265
Mailing Address - Fax:207-772-5602
Practice Address - Street 1:80 EXCHANGE ST
Practice Address - Street 2:SUITE 28
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-5035
Practice Address - Country:US
Practice Address - Phone:207-772-7265
Practice Address - Fax:207-772-5602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC3901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty