Provider Demographics
NPI:1255070041
Name:EQ MAINE LLC
Entity type:Organization
Organization Name:EQ MAINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:RUTBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DHED, LCPC
Authorized Official - Phone:207-491-6014
Mailing Address - Street 1:PO BOX 1082
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:ME
Mailing Address - Zip Code:04294-1082
Mailing Address - Country:US
Mailing Address - Phone:207-491-6014
Mailing Address - Fax:888-876-3908
Practice Address - Street 1:233 VILLAGE VIEW STREET
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:ME
Practice Address - Zip Code:04294
Practice Address - Country:US
Practice Address - Phone:207-491-6014
Practice Address - Fax:888-876-3908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty