Provider Demographics
NPI:1912051673
Name:CHILD DEVELOPMENT SERVICES-HANCOCK COUNTY
Entity Type:Organization
Organization Name:CHILD DEVELOPMENT SERVICES-HANCOCK COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:POLLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-667-7108
Mailing Address - Street 1:190 BANGOR RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-3258
Mailing Address - Country:US
Mailing Address - Phone:207-667-7108
Mailing Address - Fax:207-664-0461
Practice Address - Street 1:190 BANGOR RD
Practice Address - Street 2:SUITE A
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-3258
Practice Address - Country:US
Practice Address - Phone:207-667-7108
Practice Address - Fax:207-664-0461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 222Q00000X, 225X00000X
MEME260700235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Not Answered222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME7571150OtherAETNA OT NON-HMO
ME2372663OtherAETNA ST HMO
ME7714153OtherAETNA ST NON-HMO
ME26798250OtherAETNA OT HMO
MEMN2686OtherHARVARD PILGRIM
MEMN2686OtherHARVARD PILGRIM