Doctor Name: | ARI BOUSE |
NPI Number: | 1770864910 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | LC6835 |
Business Practice Address: | 150 Highland Ave Gardiner, ME - 043451812 |
Business Phone Number: | 2075827366 |
Business Fax Number: | 2075823142 |
Mailing Address: | 150 Highland Ave, GARDINER |
State: | ME |
Postal Code: | 043451812 |
Phone Number: | 2075827366 |
Fax Number: | 2075823142 |
NPI Enumeration Date: | 09/01/2011 |
NPI Last Update Date: | 09/01/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041S0200X |
License Number: | LC6835 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ME |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | School |
Taxonomy Definition: |