Provider Demographics
NPI:1780888420
Name:MAGELLAN HEALTH SERVICES
Entity type:Organization
Organization Name:MAGELLAN HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT EAP CONSULTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:CAS,ACSW,LCSW
Authorized Official - Phone:207-854-5416
Mailing Address - Street 1:201 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-4761
Mailing Address - Country:US
Mailing Address - Phone:207-854-5416
Mailing Address - Fax:207-854-5498
Practice Address - Street 1:201 MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-4761
Practice Address - Country:US
Practice Address - Phone:207-854-5416
Practice Address - Fax:207-854-5498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC4924305R00000X
MELC 4924305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization