Coastal Behavioral Health, LLC

Key facts

NPI

1396239208

Entity type

Organization (NPI type 2)

Primary specialty

Community/Behavioral Health Agency 251S00000X

License

LC15872 (ME)

Legal business name

COASTAL BEHAVIORAL HEALTH, LLC

Practice address

175 Lancaster St Ste 218a
Portland, ME 04101-2451

Phone

(203) 671-3788

NPI assigned

Jun 15, 2018

Organization subpart

No

Authorized official

Name

Mr. Paul Grazia, LCSW

Title

Co-Owner

Phone

(203) 671-3788

National Provider Directory

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 15, 2018.

{
    "created_epoch": "1529020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529020800000",
    "number": "1396239208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 LANCASTER ST STE 218A",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041012451",
            "telephone_number": "203-671-3788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 LANCASTER ST STE 218A",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041012451",
            "telephone_number": "203-671-3788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL BEHAVIORAL HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-15",
        "last_updated": "2018-06-15",
        "status": "A",
        "authorized_official_last_name": "GRAZIA",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "203-671-3788",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "ME",
            "license": "LC15872",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "ME",
            "license": "LC15872",
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "ME",
            "license": "LC15872",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1669850376",
            "state": "ME"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1992162390",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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All providers in Portland, ME · Community/Behavioral Health Agency in Maine