Provider Demographics
NPI:1073037099
Name:NEXT STEP DOMESTIC VIOLENCE PROJECT
Entity type:Organization
Organization Name:NEXT STEP DOMESTIC VIOLENCE PROJECT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DORATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-667-0176
Mailing Address - Street 1:PO BOX 1466
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-1466
Mailing Address - Country:US
Mailing Address - Phone:207-667-0176
Mailing Address - Fax:207-667-8033
Practice Address - Street 1:733 BANGOR RD
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-3580
Practice Address - Country:US
Practice Address - Phone:207-667-0176
Practice Address - Fax:207-667-8033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-01
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL-4560261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEXL-4560OtherLCPC-C LICENSE NUMBER