Organization
PEDS CLINIC, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARI JO ALLEN (EXECUTIVE DIRECTOR)
(207) 467-8215
Entity
Organization
Contact information
Practice address
3 WEBHANNET PL, SUITE 2, KENNEBUNK, ME 04043-7273
(207) 467-8215
Mailing address
3 WEBHANNET PL, SUITE 2, KENNEBUNK, ME 04043-7273
(207) 467-8215
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
572387
ME
101YA0400X
Addiction (Substance Use Disorder) Counselor
572387
ME
101YM0800X
Mental Health Counselor
572387
ME
103G00000X
Clinical Neuropsychologist
572387
ME
103TA0700X
Adult Development & Aging Psychologist
572387
ME
103TB0200X
Cognitive & Behavioral Psychologist
572387
ME
103TC2200X
Clinical Child & Adolescent Psychologist
572387
ME
1041C0700X
Clinical Social Worker
572387
ME
106H00000X
Marriage & Family Therapist
572387
ME
174400000X
Specialist
Primary
—
—
2080A0000X
Pediatric Adolescent Medicine Physician
572387
ME
225X00000X
Occupational Therapist
572387
ME
363LP0200X
Pediatric Nurse Practitioner
572387
ME
Other
Enumeration date
06/12/2009
Last updated
06/12/2009
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