# MAST CLINIC, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134439151
- **Authorized official:** MS. JACQUELINE D MAST PT MSED (OWNER/MANAGER/PROVIDER)
- **Authorized official phone:** (207) 892-5328

## Contact information

- **Practice address:** 1 WESTBROOK CMN, SUITE 2, WESTBROOK, ME 04092-2804
- **Practice address phone:** (207) 892-5328
- **Practice address fax:** (866) 416-3820
- **Mailing address:** 94 RACKLEFF ST, PORTLAND, ME 04103-3054
- **Mailing address phone:** (207) 892-5328

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 252Y00000X | Early Intervention Provider Agency | PT677 | ME | Yes |

## Other

- **Enumeration date:** 10/08/2010
- **Last updated:** 10/08/2010