Provider Demographics
NPI:1952538324
Name:DISCOVERING KIDS CONSULTATION SERVICE
Entity Type:Organization
Organization Name:DISCOVERING KIDS CONSULTATION SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:TOMASELLO
Authorized Official - Suffix:
Authorized Official - Credentials:BCABA
Authorized Official - Phone:207-529-2227
Mailing Address - Street 1:234 TURNER RD
Mailing Address - Street 2:
Mailing Address - City:BREMEN
Mailing Address - State:ME
Mailing Address - Zip Code:04551-3327
Mailing Address - Country:US
Mailing Address - Phone:207-529-2227
Mailing Address - Fax:207-529-2227
Practice Address - Street 1:234 TURNER RD
Practice Address - Street 2:
Practice Address - City:BREMEN
Practice Address - State:ME
Practice Address - Zip Code:04551-3327
Practice Address - Country:US
Practice Address - Phone:207-529-2227
Practice Address - Fax:207-529-2227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-12
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME431578500252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431578500Medicaid