Organization
BEACON BEHAVIOR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA ESMERALDA GRUNGLASSE LCPC (EXECUTIVE DIRECTOR)
(207) 210-2672
Entity
Organization
Contact information
Practice address
68 BISHOP ST # 3-3, PORTLAND, ME 04103-2681
(207) 210-2672
Mailing address
95 FALMOUTH RD, FALMOUTH, ME 04105-1841
(207) 210-2672
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
06/01/2021
Last updated
06/01/2021
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