| Tideside | |
|
64 Church St Tideside Ellsworth ME 04605-1658 | |
| (207) 669-6011 | |
| (207) 669-6011 |
| Full Name | Tideside |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 64 Church St, Ellsworth, Maine |
| Authorized Official Name and Position | Kenneth A. Beattie (SOLE OWNER) |
| Authorized Official Contact | 2076696011 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tideside 94 Mill St Orono ME 04473-4040 Ph: (207) 866-2636 | Tideside 64 Church St Tideside Ellsworth ME 04605-1658 Ph: (207) 669-6011 |
| NPI Number | 1275645939 |
|---|---|
| Provider Enumeration Date | 08/31/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275645939 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PS1018 (Maine) | Primary |
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