20D2094100 CLIA NUMBER - TRADECRAFT12

Laboratory Demographics

  • CLIA Code: 20D2094100
  • Facility Name: TRADECRAFT12
  • Facility Address: 160 PREBLE STREET
    PORTLAND, ME
    ZIP 04101
  • Facility Phone: 207 791-2000
  • Facility Type: Other - BEHAVIORAL HEALTH FACILIT
  • Facility Type: Waiver
  • Lab Director: JONATHAN C. FELLERS
  • NPI Number: 1740688472
  • Taxonomy: 261QR0405X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 20D2094100
LAB Type Other - BEHAVIORAL HEALTH FACILIT
Facility Name TRADECRAFT12
Street 160 PREBLE STREET
City PORTLAND
State ME
ZIP 04101
Phone 207 791-2000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/10/2025
Certificate Expiration Date 4/9/2027
Facility Type Other - BEHAVIORAL HEALTH FACILIT
Lab Director JONATHAN C. FELLERS

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