Portland Doula Collaborative

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MT2239 Issued in ME

Legal business name

PORTLAND DOULA COLLABORATIVE

Practice address

30 Upper Mast Landing Rd
Freeport, ME 04032-6417

Phone

(207) 632-1242

NPI assigned

Jun 21, 2014

Last updated

Jun 21, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mary E Latendresse, LMT, CPMT

Title

Owner, LMT, CPMT, Doula

Phone

(207) 632-1242

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1403308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403308800000",
    "number": "1548675200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 UPPER MAST LANDING RD",
            "city": "FREEPORT",
            "state": "ME",
            "postal_code": "040326417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 UPPER MAST LANDING RD",
            "city": "FREEPORT",
            "state": "ME",
            "postal_code": "040326417",
            "telephone_number": "207-632-1242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTLAND DOULA COLLABORATIVE",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-21",
        "last_updated": "2014-06-21",
        "status": "A",
        "authorized_official_last_name": "LATENDRESSE",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER, LMT, CPMT, DOULA",
        "authorized_official_telephone_number": "207-632-1242",
        "authorized_official_credential": "LMT, CPMT"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": "ME",
            "license": "MT2239",
            "primary": true
        },
        {
            "code": "374J00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Doula",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2014; 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.