Provider Demographics
NPI:1669076089
Name:EVERGREEN PSYCHIATRIC CARE LLC
Entity type:Organization
Organization Name:EVERGREEN PSYCHIATRIC CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWARZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:207-200-7738
Mailing Address - Street 1:50 MARKET ST
Mailing Address - Street 2:STE 1A PMB #232
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106
Mailing Address - Country:US
Mailing Address - Phone:207-200-7738
Mailing Address - Fax:262-661-7301
Practice Address - Street 1:50 MARKET ST
Practice Address - Street 2:STE 1A #232
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106
Practice Address - Country:US
Practice Address - Phone:207-200-7738
Practice Address - Fax:262-661-7301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty