Tennies, Diane Alicia
Tennies, Diane Alicia is an sole proprietor health care provider with primary practice located at 115 Franklin St Suite 1A, Bangor ME 04401-4936. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Forensic. Behavioral Health & Social Service Providers / Forensic is her primary health care specialty. Tennies, Diane Alicia can be contacted via phone (207) 942-3635.Contact Information
Primary practice address
115 Franklin St Suite 1A
Bangor ME 04401-4936
Phone: (207) 942-3635
Fax: (207) 941-1933
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) | 103TA0400X | LC 1572 | Maine |
| Behavioral Health & Social Service Providers / Forensic | 103TF0200X | PS955 | Maine |
Profile Details
| NPI number | 1023168531 |
|---|---|
| LBN Legal business name | Tennies, Diane Alicia |
| Credentials | PH.D. |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jan 10th, 2007 |
| Last updated | Apr 16th, 2013 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1023168531 | NPPES |
| Maine | Other | 043983 | BLUE CROSS BLUE SHIELD |
| Maine | MEDICAID | 231220000 | BLUE CROSS BLUE SHIELD |
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