Provider Demographics
NPI:1982076485
Name:FORESIDE BEHAVIOR ASSOCIATES
Entity Type:Organization
Organization Name:FORESIDE BEHAVIOR ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JARMUZ-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, BCBA-D
Authorized Official - Phone:207-613-7324
Mailing Address - Street 1:1321 WASHINGTON AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-3675
Mailing Address - Country:US
Mailing Address - Phone:207-613-7324
Mailing Address - Fax:207-613-7333
Practice Address - Street 1:1321 WASHINGTON AVE STE 302
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-3675
Practice Address - Country:US
Practice Address - Phone:207-613-7324
Practice Address - Fax:207-613-7333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-22
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1164824082OtherNPI
1316321946OtherNPI