Provider Demographics
NPI:1043646458
Name:PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LEBLANC
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:207-274-3354
Mailing Address - Street 1:6 CHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-2122
Mailing Address - Country:US
Mailing Address - Phone:207-274-3354
Mailing Address - Fax:207-766-5628
Practice Address - Street 1:6 CHESTER AVE
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-2122
Practice Address - Country:US
Practice Address - Phone:207-274-3354
Practice Address - Fax:207-766-5628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1145103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty