Maine Geropsychology, LLC

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

License

PS1413 Issued in ME

Legal business name

MAINE GEROPSYCHOLOGY, LLC

Practice address

14 Maine St
Suite 111-C
Brunswick, ME 04011-2049

Phone

(207) 721-8143

Fax

(207) 721-8143

NPI assigned

Oct 21, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Martin Morthland, PH.D.

Title

Owner

Phone

(207) 721-8143

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1445385600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1446595200000",
    "number": "1144692880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 MAINE ST",
            "address_2": "SUITE 111-C",
            "city": "BRUNSWICK",
            "state": "ME",
            "postal_code": "040112049",
            "telephone_number": "207-721-8143",
            "fax_number": "207-721-8143"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 MAINE ST",
            "address_2": "SUITE 111-C",
            "city": "BRUNSWICK",
            "state": "ME",
            "postal_code": "040112049",
            "telephone_number": "207-721-8143",
            "fax_number": "207-721-8143"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAINE GEROPSYCHOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-21",
        "last_updated": "2015-11-04",
        "status": "A",
        "authorized_official_last_name": "MORTHLAND",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "207-721-8143",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "ME",
            "license": "PS1413",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adult Mental Health Clinic/Center in Brunswick, ME
• Providers in Brunswick, ME by specialty
• Adult Mental Health Clinic/Center in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2015; 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.