Provider Demographics
NPI:1346791829
Name:KEMBERLING AND WILLEY PA
Entity Type:Organization
Organization Name:KEMBERLING AND WILLEY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:207-230-1177
Mailing Address - Street 1:71 ELM ST STE 1
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04843-1904
Mailing Address - Country:US
Mailing Address - Phone:207-230-1177
Mailing Address - Fax:207-230-1177
Practice Address - Street 1:71 ELM ST STE 1
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:ME
Practice Address - Zip Code:04843-1904
Practice Address - Country:US
Practice Address - Phone:207-230-1177
Practice Address - Fax:207-230-1177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty