Provider Demographics
NPI:1346275013
Name:WERRBACH, JAMES W (PHD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:W
Last Name:WERRBACH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:43 WHITING HILL RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1005
Mailing Address - Country:US
Mailing Address - Phone:207-973-5035
Mailing Address - Fax:207-973-5042
Practice Address - Street 1:895 UNION ST
Practice Address - Street 2:SUITE 12
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3053
Practice Address - Country:US
Practice Address - Phone:207-973-7979
Practice Address - Fax:207-947-9579
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS751103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM4356Medicare ID - Type Unspecified