Provider Demographics
NPI:1376684787
Name:SEYMOUR, RICHARD DEVILLERS (ED D)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:DEVILLERS
Last Name:SEYMOUR
Suffix:
Gender:M
Credentials:ED D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-3809
Mailing Address - Country:US
Mailing Address - Phone:207-841-9418
Mailing Address - Fax:207-798-3929
Practice Address - Street 1:132 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-3809
Practice Address - Country:US
Practice Address - Phone:207-841-9418
Practice Address - Fax:207-798-3929
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS827103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME017233OtherANTHEM BCBS
MEMM5568Medicare ID - Type Unspecified