| White Crescent Wellness, Llc | |
|
222 Saint John St Ste 314 Portland ME 04102-3059 | |
| (508) 314-3084 | |
| Not Available |
| Full Name | White Crescent Wellness, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 222 Saint John St Ste 314, Portland, Maine |
| Authorized Official Name and Position | Julia Hagen (OWNER/PROVIDER) |
| Authorized Official Contact | 5083143084 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| White Crescent Wellness, Llc 222 Saint John St Ste 314 Portland ME 04102-3059 Ph: () - | White Crescent Wellness, Llc 222 Saint John St Ste 314 Portland ME 04102-3059 Ph: (508) 314-3084 |
| NPI Number | 1699273607 |
|---|---|
| Provider Enumeration Date | 01/24/2018 |
| Last Update Date | 01/24/2018 |
| Medicare PECOS PAC ID | 1456612738 |
|---|---|
| Medicare Enrollment ID | O20180301000595 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699273607 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Julia H Hagen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376978718 PECOS PAC ID: 0345473195 Enrollment ID: I20140430002202 |
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