Basic Information
| Provider Information | |||||||||
| NPI: | 1639596174 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FOSS | ||||||||
| FirstName: | MAUREEN | ||||||||
| MiddleName: | |||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 39 BANGOR ST | ||||||||
| Address2: | |||||||||
| City: | HOULTON | ||||||||
| State: | ME | ||||||||
| PostalCode: | 047301711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2075215230 | ||||||||
| FaxNumber: | 8555962438 | ||||||||
| Practice Location | |||||||||
| Address1: | 1325 S STATE ST | ||||||||
| Address2: | |||||||||
| City: | DOVER | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199014945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3022443404 | ||||||||
| FaxNumber: | 8555962438 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2014 | ||||||||
| LastUpdateDate: | 04/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 0133000410 | VA | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 1295235448 | 05 | DE | MEDICAID | 1295235448 | 05 | ME | MEDICAID |