East Coast Wellness Llc | |
553 Shore Rd Ste 2 Cape Elizabeth ME 04107-1010 | |
(207) 400-5876 | |
Not Available |
Full Name | East Coast Wellness Llc |
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Speciality | Psychologist |
Location | 553 Shore Rd Ste 2, Cape Elizabeth, Maine |
Authorized Official Name and Position | Loren Bush (CLINICAL PSYCHOLOGIST) |
Authorized Official Contact | 2074005092 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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East Coast Wellness Llc 553 Shore Rd Ste 2 Cape Elizabeth ME 04107-1010 Ph: (207) 400-5876 | East Coast Wellness Llc 553 Shore Rd Ste 2 Cape Elizabeth ME 04107-1010 Ph: (207) 400-5876 |
NPI Number | 1447727466 |
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Provider Enumeration Date | 10/29/2018 |
Last Update Date | 09/13/2021 |
Certification Date | 09/13/2021 |
Medicare PECOS PAC ID | 5799028163 |
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Medicare Enrollment ID | O20190529000316 |
Identifier | Type | State | Issuer |
---|---|---|---|
1447727466 | NPI | - | NPPES |
E300280666 | Medicaid | ME | |
E300279945 | Medicaid | ME |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
Provider Name | Loren M Bush |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1437539210 PECOS PAC ID: 0446556237 Enrollment ID: I20160303001522 |
Provider Name | Quynn W Morehouse |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1982074373 PECOS PAC ID: 3577869239 Enrollment ID: I20160308000096 |
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