Basic Information
| Provider Information | |||||||||
| NPI: | 1003059189 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MURCHISON | ||||||||
| FirstName: | MAUREEN | ||||||||
| MiddleName: | N. | ||||||||
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| Credential: | CBIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 159 BENNETT DR STE 210 | ||||||||
| Address2: | |||||||||
| City: | CARIBOU | ||||||||
| State: | ME | ||||||||
| PostalCode: | 047362049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074983820 | ||||||||
| FaxNumber: | 2074983591 | ||||||||
| Practice Location | |||||||||
| Address1: | 159 BENNETT DR STE 201 | ||||||||
| Address2: | |||||||||
| City: | CARIBOU | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074983820 | ||||||||
| FaxNumber: | 2074983591 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2009 | ||||||||
| LastUpdateDate: | 06/07/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225C00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Counselor |
ID Information
| ID | Type | State | Issuer | Description | 432726599 | 05 | ME | MEDICAID |