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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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 11 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1023168531 NPPES
Maine Other 043983 BLUE CROSS BLUE SHIELD
Maine MEDICAID 231220000 BLUE CROSS BLUE SHIELD

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