Provider Demographics
NPI:1700996063
Name:UMBRELLA MENTAL HEALTH SERVICES, PA
Entity Type:Organization
Organization Name:UMBRELLA MENTAL HEALTH SERVICES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:AVERILL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:207-563-3022
Mailing Address - Street 1:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:NOBLEBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04555-0157
Mailing Address - Country:US
Mailing Address - Phone:207-563-3022
Mailing Address - Fax:207-563-3061
Practice Address - Street 1:73 BISCAY RD
Practice Address - Street 2:
Practice Address - City:DAMARISCOTTA
Practice Address - State:ME
Practice Address - Zip Code:04543-4614
Practice Address - Country:US
Practice Address - Phone:207-563-3022
Practice Address - Fax:207-563-3061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME486719101YM0800X, 364SP0807X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & AdolescentGroup - Multi-Specialty
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, AdultGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432269200Medicaid
ME9187290OtherAETNA
MEME-2085Medicare PIN