| NPI | 1861464380 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER S FOURNIER Credentialing Rep 207-376-5405 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: ME AP081017) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2012-11-30 |