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229b Main St Waterville ME 04901-6119 | |
| (207) 578-2244 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 229b Main St, Waterville, Maine |
| Authorized Official Name and Position | Amy M Tardy (OWNER, CLINICAL DIRECTOR) |
| Authorized Official Contact | 2075782244 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1353 Mercer Rd Mercer ME 04957-4469 Ph: () - | 229b Main St Waterville ME 04901-6119 Ph: (207) 578-2244 |
| NPI Number | 1346015088 |
|---|---|
| Provider Enumeration Date | 11/22/2023 |
| Last Update Date | 12/02/2023 |
| Certification Date | 12/02/2023 |
| Medicare PECOS PAC ID | 9739628587 |
|---|---|
| Medicare Enrollment ID | O20240826001418 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346015088 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Amy Tardy |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1780233445 PECOS PAC ID: 6002264207 Enrollment ID: I20240110001547 |
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