Provider Demographics
NPI:1154606671
Name:CEDAR STREET PRESCHOOL INC
Entity type:Organization
Organization Name:CEDAR STREET PRESCHOOL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARYBETH
Authorized Official - Middle Name:D
Authorized Official - Last Name:PRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:CCC SLP
Authorized Official - Phone:207-208-7233
Mailing Address - Street 1:78 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04841-3146
Mailing Address - Country:US
Mailing Address - Phone:202-208-7233
Mailing Address - Fax:
Practice Address - Street 1:78 CEDAR ST
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841-3146
Practice Address - Country:US
Practice Address - Phone:202-208-7233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-16
Last Update Date:2011-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP1303235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME263810000Medicaid