20D2079587 CLIA NUMBER - MAINEHEALTH DBA MMC OUTPATIENT PSYCHIATRY

Laboratory Demographics

  • CLIA Code: 20D2079587
  • Facility Name: MAINEHEALTH DBA MMC OUTPATIENT PSYCHIATRY
  • Facility Address: 216 VAUGHAN STREET
    PORTLAND, ME
    ZIP 04102
  • Facility Phone: 207 662-2015
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CHARLES J. MALLO
  • NPI Number: 1447623996
  • Taxonomy: 282N00000X - General Acute Care Hospital

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CLIA Record

Field Name Field Value
CLIA Number 20D2079587
LAB Type Physician Office
Facility Name MAINEHEALTH DBA MMC OUTPATIENT PSYCHIATRY
Street 216 VAUGHAN STREET
City PORTLAND
State ME
ZIP 04102
Phone 207 662-2015
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/18/2024
Certificate Expiration Date 6/17/2026
Facility Type Physician Office
Lab Director CHARLES J. MALLO

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This page was last updated on: 9/29/2025