Provider Demographics
NPI:1386652634
Name:DOIRON, RICHARD G (PHD, ABPP)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:G
Last Name:DOIRON
Suffix:
Gender:M
Credentials:PHD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 FLINTLOCK DR
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9329
Mailing Address - Country:US
Mailing Address - Phone:207-883-6773
Mailing Address - Fax:
Practice Address - Street 1:86 DARTMOUTH ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-4808
Practice Address - Country:US
Practice Address - Phone:207-773-1790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS159103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME002997OtherANTHEM BLUE CROSS BLUE SH
ME703228Medicare ID - Type Unspecified