Provider Demographics
NPI:1245395532
Name:CURLESS, MICHAEL WILLIAM (PHD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:WILLIAM
Last Name:CURLESS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 439
Mailing Address - Street 2:
Mailing Address - City:SOUTHWEST HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04679-0439
Mailing Address - Country:US
Mailing Address - Phone:207-244-0020
Mailing Address - Fax:207-244-0587
Practice Address - Street 1:19 CLARK POINT ROAD
Practice Address - Street 2:SUITE 101 U
Practice Address - City:SOUTHWEST HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04679-0439
Practice Address - Country:US
Practice Address - Phone:207-244-0020
Practice Address - Fax:207-244-0587
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1055103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME044921OtherANTHEM
MEMM9499Medicare ID - Type Unspecified