Provider Demographics
NPI:1043432628
Name:MAINE NEUROBEHAVIORAL SERVICES, P.A.
Entity type:Organization
Organization Name:MAINE NEUROBEHAVIORAL SERVICES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLELLAND
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:207-781-8977
Mailing Address - Street 1:PO BOX 302
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-0302
Mailing Address - Country:US
Mailing Address - Phone:207-838-5688
Mailing Address - Fax:207-846-7756
Practice Address - Street 1:21 NORTHBROOK DR
Practice Address - Street 2:SUITE 21B
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1346
Practice Address - Country:US
Practice Address - Phone:207-781-8977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS875103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM9173Medicare ID - Type Unspecified