| Island Institute For Trauma Recovery Llc | |
|
199 Main St Saco ME 04072-1508 | |
| (207) 571-3008 | |
| Not Available |
| Full Name | Island Institute For Trauma Recovery Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 199 Main St, Saco, Maine |
| Authorized Official Name and Position | Rudolph Albert Skowronski (PARTNER) |
| Authorized Official Contact | 2075713008 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Island Institute For Trauma Recovery Llc Po Box 1189 Saco ME 04072-1189 Ph: (207) 229-2398 | Island Institute For Trauma Recovery Llc 199 Main St Saco ME 04072-1508 Ph: (207) 571-3008 |
| NPI Number | 1174853717 |
|---|---|
| Provider Enumeration Date | 01/04/2010 |
| Last Update Date | 12/08/2022 |
| Certification Date | 12/08/2022 |
| Medicare PECOS PAC ID | 6305110438 |
|---|---|
| Medicare Enrollment ID | O20170927004153 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174853717 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Rudolph Albert Skowronski |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386680858 PECOS PAC ID: 0143121285 Enrollment ID: I20040220000917 |
| Provider Name | Philip R Deveau |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053445767 PECOS PAC ID: 4789730896 Enrollment ID: I20090915000282 |
| Provider Name | Jennifer M West |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083924336 PECOS PAC ID: 5799934543 Enrollment ID: I20121011000272 |
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