Individual
MRS. MARY ELLEN LEE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
727 N MAIN ST, BREWER, ME 04412-1260
(207) 907-4160
(207) 907-4160
Mailing address
727 N MAIN ST, BREWER, ME 04412-1260
(207) 907-4160
(207) 907-4160
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3002923
MAINECARE PROVIDER LICENSE NUMBER
ME
01
—
432802900
MAINECARE BILLING NUMBER
ME
01
—
VC0000112845
MAINECARE VENDOR NUMBER
ME
Enumeration date
12/08/2009
Last updated
12/08/2009
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