Individual
MR. E. TERRANCE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
62 MELBOURNE STREET, PORTLAND, ME 04101-2727
(207) 318-5672
Mailing address
62 MELBOURNE STREET, PORTLAND, ME 04101-2727
(207) 318-5672
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
432750300
—
ME
Enumeration date
06/30/2009
Last updated
06/30/2009
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