Provider Demographics
NPI:1114615937
Name:MAINELY PSYCHOLOGY LLC
Entity Type:Organization
Organization Name:MAINELY PSYCHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CADY
Authorized Official - Middle Name:VICTORIA
Authorized Official - Last Name:KINTNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:207-407-5915
Mailing Address - Street 1:1192 ISLAND ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-3525
Mailing Address - Country:US
Mailing Address - Phone:650-387-3541
Mailing Address - Fax:
Practice Address - Street 1:1192 ISLAND ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-3525
Practice Address - Country:US
Practice Address - Phone:650-387-3541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-28
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty