| Ucp Of Maine | |
|
700 Mount Hope Ave Suite 320 Bangor ME 04401-5680 | |
| (207) 941-2952 | |
| (207) 941-2955 |
| Full Name | Ucp Of Maine |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 700 Mount Hope Ave, Bangor, Maine |
| Authorized Official Name and Position | Candice M Madore (BILLING SPECIALIST) |
| Authorized Official Contact | 2079920602 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ucp Of Maine 700 Mount Hope Ave Suite 320 Bangor ME 04401-5680 Ph: (207) 941-2952 | Ucp Of Maine 700 Mount Hope Ave Suite 320 Bangor ME 04401-5680 Ph: (207) 941-2952 |
| NPI Number | 1265634893 |
|---|---|
| Provider Enumeration Date | 06/05/2007 |
| Last Update Date | 11/29/2012 |
| Medicare PECOS PAC ID | 6507018058 |
|---|---|
| Medicare Enrollment ID | O20121206000540 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265634893 | NPI | - | NPPES |
| 167950200 | Medicaid | ME |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | CC3374 (Maine) | Primary |
| Provider Name | Katharine J Disalvatore Fortin |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1992877765 PECOS PAC ID: 6709902828 Enrollment ID: I20100927000852 |
| Provider Name | Amanda V Prescott |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497056550 PECOS PAC ID: 5799930905 Enrollment ID: I20130219000168 |
| Provider Name | Christine Ac Richard |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013343813 PECOS PAC ID: 5395098099 Enrollment ID: I20181026000303 |
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