Basic Information
| Provider Information | |||||||||
| NPI: | 1801209218 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SINES | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | |||||||||
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| Credential: | CADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 180 ACADEMY ST STE 3 | ||||||||
| Address2: | |||||||||
| City: | PRESQUE ISLE | ||||||||
| State: | ME | ||||||||
| PostalCode: | 047693183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2075542352 | ||||||||
| FaxNumber: | 2075542351 | ||||||||
| Practice Location | |||||||||
| Address1: | 8 WESLEYAN ST | ||||||||
| Address2: | |||||||||
| City: | FORT FAIRFIELD | ||||||||
| State: | ME | ||||||||
| PostalCode: | 047422010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074739285 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2014 | ||||||||
| LastUpdateDate: | 02/02/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
ID Information
| ID | Type | State | Issuer | Description | 1801209218 | 05 | ME | MEDICAID |