# PSYCHMAINE LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PsychMaine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1891409025
- **Authorized official:** JONATHAN C FELLERS MD (PSYCHIATRIST)
- **Authorized official phone:** (207) 221-0635

## Contact information

- **Practice address:** 550 FOREST AVE STE 103, PORTLAND, ME 04101-1505
- **Practice address phone:** (207) 221-0635
- **Practice address fax:** (207) 221-0634
- **Mailing address:** 550 FOREST AVE STE 103, PORTLAND, ME 04101-1505
- **Mailing address phone:** (207) 221-0635
- **Mailing address fax:** (207) 221-0634

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YP2500X | Professional Counselor | — | NULL | — |
| 101YP2500X | Professional Counselor | — | — | — |
| 163W00000X | Registered Nurse | — | NULL | — |
| 163W00000X | Registered Nurse | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 2083A0300X | Addiction Medicine (Preventive Medicine) Physician | — | NULL | — |
| 2083A0300X | Addiction Medicine (Preventive Medicine) Physician | — | — | — |
| 2084P0800X | Psychiatry Physician | — | NULL | — |
| 2084P0800X | Psychiatry Physician | — | — | — |
| 2084P0802X | Addiction Psychiatry Physician | — | NULL | — |
| 2084P0802X | Addiction Psychiatry Physician | — | — | — |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 01/11/2023
- **Last updated:** 03/01/2023