| Southern Maine Psychotherapy Llc | |
|
20 Mussey Rd Scarborough ME 04074-9570 | |
| (207) 200-5621 | |
| Not Available |
| Full Name | Southern Maine Psychotherapy Llc |
|---|---|
| Speciality | Social Worker |
| Location | 20 Mussey Rd, Scarborough, Maine |
| Authorized Official Name and Position | Michael Johnston (PROVIDER/OWNER) |
| Authorized Official Contact | 2072005621 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Maine Psychotherapy Llc 723 Sawyer St South Portland ME 04106-4642 Ph: (207) 200-5621 | Southern Maine Psychotherapy Llc 20 Mussey Rd Scarborough ME 04074-9570 Ph: (207) 200-5621 |
| NPI Number | 1164299194 |
|---|---|
| Provider Enumeration Date | 12/11/2023 |
| Last Update Date | 01/22/2024 |
| Certification Date | 01/22/2024 |
| Medicare PECOS PAC ID | 2264879907 |
|---|---|
| Medicare Enrollment ID | O20240318002040 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164299194 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Michael Johnston |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194374355 PECOS PAC ID: 1850780263 Enrollment ID: I20211104003173 |
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