Provider Demographics
NPI:1740344514
Name:A CENTER FOR THE AWARENESS OF PATTERN
Entity type:Organization
Organization Name:A CENTER FOR THE AWARENESS OF PATTERN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PHOEBE
Authorized Official - Middle Name:SMOVER
Authorized Official - Last Name:PROSKY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:207-865-3396
Mailing Address - Street 1:143 FLYING POINT RD
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032
Mailing Address - Country:US
Mailing Address - Phone:207-865-3396
Mailing Address - Fax:207-865-1213
Practice Address - Street 1:143 FLYING POINT RD
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:ME
Practice Address - Zip Code:04032
Practice Address - Country:US
Practice Address - Phone:207-865-3396
Practice Address - Fax:207-865-1213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME334941261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME154320000Medicaid
ME154320000Medicaid