Provider Demographics
NPI:1700814712
Name:PROTEA BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:PROTEA BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROWENA
Authorized Official - Middle Name:
Authorized Official - Last Name:TESSMANN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:207-992-7010
Mailing Address - Street 1:33 STATE ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5038
Mailing Address - Country:US
Mailing Address - Phone:207-992-7010
Mailing Address - Fax:207-992-7011
Practice Address - Street 1:33 STATE ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5038
Practice Address - Country:US
Practice Address - Phone:207-992-7010
Practice Address - Fax:207-992-7011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME031509OtherANTHEM FACILITY ID#
ME1003100101Medicaid
ME031509OtherANTHEM FACILITY ID#
MEMM8993Medicare ID - Type UnspecifiedNORTHEN MAINE ID#