| Behavioral Health Resources Of Maine Inc | |
|
305 Commercial St Ste 103 Portland ME 04101-4641 | |
| (207) 808-1384 | |
| (207) 767-6595 |
| Full Name | Behavioral Health Resources Of Maine Inc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 305 Commercial St Ste 103, Portland, Maine |
| Authorized Official Name and Position | Constance W Jordan (CEO) |
| Authorized Official Contact | 2078081384 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Behavioral Health Resources Of Maine Inc 305 Commercial St Ste 103 Portland ME 04101-4641 Ph: (207) 808-1384 | Behavioral Health Resources Of Maine Inc 305 Commercial St Ste 103 Portland ME 04101-4641 Ph: (207) 808-1384 |
| NPI Number | 1811303373 |
|---|---|
| Provider Enumeration Date | 07/06/2014 |
| Last Update Date | 10/15/2020 |
| Certification Date | 10/15/2020 |
| Medicare PECOS PAC ID | 9739495524 |
|---|---|
| Medicare Enrollment ID | O20150824001839 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811303373 | NPI | - | NPPES |
| METPID005674 | Medicaid | ME |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | LC2233 (Maine) | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | CNP81017 (Maine) | Primary |
| Provider Name | Anne M Rogerson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255965190 PECOS PAC ID: 9032539614 Enrollment ID: I20201020002836 |
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