Provider Demographics
NPI:1063601060
Name:OCEANSIDE COMMUNITY SERVICES
Entity type:Organization
Organization Name:OCEANSIDE COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:NEGOESCU
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:207-571-9923
Mailing Address - Street 1:209 MAIN ST
Mailing Address - Street 2:SUITE 302 & 303
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-1566
Mailing Address - Country:US
Mailing Address - Phone:207-571-9923
Mailing Address - Fax:207-571-9927
Practice Address - Street 1:209 MAIN ST
Practice Address - Street 2:SUITE 302 & 303
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-1566
Practice Address - Country:US
Practice Address - Phone:207-571-9923
Practice Address - Fax:207-571-9927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME595034251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health