Provider Demographics
NPI:1285666321
Name:WILLEY, VICKY L (PHD)
Entity Type:Individual
Prefix:
First Name:VICKY
Middle Name:L
Last Name:WILLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 MECHANIC ST
Mailing Address - Street 2:SUITE 221
Mailing Address - City:CAMDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04843-1842
Mailing Address - Country:US
Mailing Address - Phone:207-230-1177
Mailing Address - Fax:207-230-1177
Practice Address - Street 1:39 MECHANIC ST
Practice Address - Street 2:SUITE 221
Practice Address - City:CAMDEN
Practice Address - State:ME
Practice Address - Zip Code:04843-1842
Practice Address - Country:US
Practice Address - Phone:207-230-1177
Practice Address - Fax:207-230-1177
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1187103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME154420000Medicaid