Provider Demographics
NPI:1457774598
Name:DIVERSIFIED LEARNING PATHWAYS
Entity type:Organization
Organization Name:DIVERSIFIED LEARNING PATHWAYS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDSAE
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:KISH
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:207-664-9474
Mailing Address - Street 1:305 BAGADUCE RD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04617-3803
Mailing Address - Country:US
Mailing Address - Phone:207-664-9474
Mailing Address - Fax:
Practice Address - Street 1:305 BAGADUCE RD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:ME
Practice Address - Zip Code:04617-3803
Practice Address - Country:US
Practice Address - Phone:207-664-9474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-25
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health