NPIMap

Organization Active NPI

Wabanaki Public Health and Wellness

  • Addiction (Substance Use Disorder) Psychologist
  • Bangor, ME
National Provider Identifier
1689335184
Registry record updated Jan 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) PsychologistTaxonomy code 103TA0400X
Legal business name
WABANAKI PUBLIC HEALTH AND WELLNESS
Practice address
157 Park St
Bangor, ME 04401-5093
Phone
(207) 631-1536
Fax
(207) 631-0524
NPI assigned
Jan 6, 2022
Last updated
Jan 6, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2022

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

Authorized official

Name
Sharon Mae Jordan, LCSWNPI 1598849671
Title
Director
Phone
(207) 992-0411

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TA0400X Primary
Case Management Agency 251B00000X
Public Health or Welfare Agency 251K00000X
Community/Behavioral Health Agency 251S00000X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X

Addresses

Primary practice location

157 Park St
Bangor, ME 04401-5093

Mailing address

PO Box 1356
Bangor, ME 04402-1356
Phone (207) 992-0411

Other practice location 1

57 Penobscot Ave
Millinocket, ME 04462-1320
Phone (207) 631-1536

National Provider Directory

National Provider Directory

Locations

68 Mount Hope Ave
Ste 2
Bangor, ME 04401
Phone (207) 573-1794

57 Penobscot Ave
Millinocket, ME 04462
Phone (207) 631-1536

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1641427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641427200000",
    "number": "1689335184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1356",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044021356",
            "telephone_number": "207-992-0411",
            "fax_number": "207-631-0524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "157 PARK ST",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044015093",
            "telephone_number": "207-631-1536",
            "fax_number": "207-631-0524"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "57 Penobscot Ave",
            "address_purpose": "LOCATION",
            "city": "Millinocket",
            "state": "ME",
            "postal_code": "044621320",
            "country_code": "US",
            "telephone_number": "207-631-1536",
            "fax_number": "207-631-0524",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WABANAKI PUBLIC HEALTH AND WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-06",
        "last_updated": "2022-01-06",
        "certification_date": "2022-01-06",
        "status": "A",
        "authorized_official_last_name": "JORDAN",
        "authorized_official_first_name": "SHARON",
        "authorized_official_middle_name": "MAE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "207-992-0411",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "103TA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bangor, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2022; 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.