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30 Blueberry Rd Portland ME 04102-1924 | |
| (207) 939-8780 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 30 Blueberry Rd, Portland, Maine |
| Authorized Official Name and Position | Ali Ashour (OWNER) |
| Authorized Official Contact | 2079398780 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
30 Blueberry Rd Portland ME 04102-1924 Ph: (207) 939-8780 | 30 Blueberry Rd Portland ME 04102-1924 Ph: (207) 939-8780 |
| NPI Number | 1821654112 |
|---|---|
| Provider Enumeration Date | 05/13/2019 |
| Last Update Date | 02/02/2024 |
| Certification Date | 02/02/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821654112 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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