Organization
EAST COAST WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LOREN BUSH PSYD (CLINICAL PSYCHOLOGIST)
(207) 400-5092
Entity
Organization
Contact information
Practice address
553 SHORE RD STE 2, CAPE ELIZABETH, ME 04107-1010
(207) 400-5876
Mailing address
553 SHORE RD STE 2, CAPE ELIZABETH, ME 04107-1010
(207) 400-5876
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
E300279945
—
ME
05
—
E300280666
—
ME
Enumeration date
10/29/2018
Last updated
09/13/2021
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