Provider Demographics
NPI:1689430415
Name:SNOW MOON THERAPY SERVICES LLC
Entity type:Organization
Organization Name:SNOW MOON THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MADELYN
Authorized Official - Middle Name:ALEXANDRA
Authorized Official - Last Name:SAUGET
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:618-340-8141
Mailing Address - Street 1:369 MAIN ST APT C
Mailing Address - Street 2:
Mailing Address - City:SOUTH BERWICK
Mailing Address - State:ME
Mailing Address - Zip Code:03908-1325
Mailing Address - Country:US
Mailing Address - Phone:618-340-8141
Mailing Address - Fax:
Practice Address - Street 1:169 PORT ROAD SUITE 16
Practice Address - Street 2:MAILBOX
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-1325
Practice Address - Country:US
Practice Address - Phone:207-558-2308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-28
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Single Specialty