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Organization
STONYBROOK MENTAL HEALTH
Active
Organization
STONYBROOK MENTAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD G COREY (OWNER)
(207) 664-8529
Entity
Organization
Contact information
Practice address
875 HAMMOND ST, BANGOR, ME 04401-4303
(207) 664-8529
Mailing address
PO BOX 72, HOLDEN, ME 04429-0072
(207) 664-8529
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
NULL
252Y00000X
Early Intervention Provider Agency
Primary
—
NULL
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
NULL
Other
Enumeration date
06/08/2018
Last updated
06/08/2018
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