Provider Demographics
NPI:1083120661
Name:VAGT, DENISE S (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:S
Last Name:VAGT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 BIRCH AVE
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-1804
Mailing Address - Country:US
Mailing Address - Phone:207-412-0429
Mailing Address - Fax:
Practice Address - Street 1:24 BIRCH AVE
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1804
Practice Address - Country:US
Practice Address - Phone:207-412-0429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-19
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist