The Aware Center for Early Intervention, LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PS1219 Issued in ME

Legal business name

THE AWARE CENTER FOR EARLY INTERVENTION, LLC

Practice address

61 Main St
Suite 53
Bangor, ME 04401-6397

Phone

(207) 208-8301

Fax

(877) 320-4344

NPI assigned

Feb 24, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jessica Pollard, PHD

Title

Director

Phone

(207) 208-8301

Specialties & licenses 3

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1298505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1298505600000",
    "number": "1134426323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "61 MAIN ST",
            "address_2": "SUITE 53",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044016397",
            "telephone_number": "207-208-8301",
            "fax_number": "877-320-4344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "61 MAIN ST",
            "address_2": "SUITE 53",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044016397",
            "telephone_number": "207-208-8301",
            "fax_number": "877-320-4344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE AWARE CENTER FOR EARLY INTERVENTION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-24",
        "last_updated": "2011-02-24",
        "status": "A",
        "authorized_official_last_name": "POLLARD",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "207-208-8301",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "ME",
            "license": "PS1219",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "ME",
            "license": "LC10927",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "ME",
            "license": "AP081171",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nina Tekelenburg
• Lucus Temple, LMSW-CC
• Diane Alicia Tennies, PH.D.
• Manika Thakur, MD
• Jessica Thayer, DMD
• The Bangor Area Homeless Shelter
• The Bodyworks
• The Getchell Agency, Inc
• The Getchell Agency, Inc
• The Maine Fitness Store, Inc

• Clinical Psychologist in Bangor, ME
• Providers in Bangor, ME by specialty
• Clinical Psychologist in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.