Provider Demographics
NPI:1740272129
Name:CROSSROADS FOR WOMEN, INC.
Entity type:Organization
Organization Name:CROSSROADS FOR WOMEN, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:POLLY
Authorized Official - Middle Name:HAIGHT
Authorized Official - Last Name:FRAWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-773-9931
Mailing Address - Street 1:71 US ROUTE 1
Mailing Address - Street 2:SUITE E
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-7173
Mailing Address - Country:US
Mailing Address - Phone:207-773-9931
Mailing Address - Fax:207-879-5576
Practice Address - Street 1:71 US ROUTE 1
Practice Address - Street 2:SUITE E
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7173
Practice Address - Country:US
Practice Address - Phone:207-773-9931
Practice Address - Fax:207-879-5576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME221001101Y00000X
ME399004101YM0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME124450000Medicaid