| Organization Name: | BANGOR INTEGRATIVE HEALTH |
| NPI Number: | 1659486884 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LEONA CERKOVITZ (OWNER/PROVIDER) |
| Mailing Address: | 192 Park St Orono |
| State: | ME US |
| Postal Code: | 044734602 |
| Phone Number: | 2078669025 |
| Fax Number: | 2078662207 |
| NPI Enumeration Date: | 08/20/2006 |
| NPI Last Update Date: | 06/22/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WP0808X |
| License Number: | 038985 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | ME |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |