| Tracy George Llc | |
|
45 Pleasant Ave Portland ME 04103-3217 | |
| (603) 343-6352 | |
| (207) 221-1219 |
| Full Name | Tracy George Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 45 Pleasant Ave, Portland, Maine |
| Authorized Official Name and Position | Tracy E George (CEO) |
| Authorized Official Contact | 6033436352 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tracy George Llc 41 Topaz Pl Portsmouth NH 03801-3583 Ph: (603) 343-6352 | Tracy George Llc 45 Pleasant Ave Portland ME 04103-3217 Ph: (603) 343-6352 |
| NPI Number | 1710434170 |
|---|---|
| Provider Enumeration Date | 09/02/2016 |
| Last Update Date | 09/02/2016 |
| Medicare PECOS PAC ID | 2062796899 |
|---|---|
| Medicare Enrollment ID | O20210113001500 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710434170 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | LC15680 (Maine) | Primary |
| Provider Name | Tracy E George |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720259047 PECOS PAC ID: 2961417704 Enrollment ID: I20060215000163 |
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