Provider Demographics
NPI:1427319359
Name:MANY MOONS PSYCHOTHERAPY SERVICES, INC.
Entity type:Organization
Organization Name:MANY MOONS PSYCHOTHERAPY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PROFESSIONAL COUN
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:H
Authorized Official - Last Name:PONTTI
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:207-504-2664
Mailing Address - Street 1:4 COTTAGE STREET
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032
Mailing Address - Country:US
Mailing Address - Phone:207-504-2664
Mailing Address - Fax:207-865-2004
Practice Address - Street 1:4 COTTAGE STREET
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:ME
Practice Address - Zip Code:04032
Practice Address - Country:US
Practice Address - Phone:207-504-2664
Practice Address - Fax:207-865-2004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC2454101YP2500X
CC2454101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty