Provider Demographics
NPI:1245628478
Name:KIDSPEACE NEW ENGLAND
Entity type:Organization
Organization Name:KIDSPEACE NEW ENGLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC-C
Authorized Official - Phone:207-941-1414
Mailing Address - Street 1:444 STILLWATER AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3521
Mailing Address - Country:US
Mailing Address - Phone:207-941-1414
Mailing Address - Fax:
Practice Address - Street 1:444 STILLWATER AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3521
Practice Address - Country:US
Practice Address - Phone:207-941-1414
Practice Address - Fax:207-947-6278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL4436251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health