Provider Demographics
NPI:1407074206
Name:SCHWAB, MICHELLE D (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:D
Last Name:SCHWAB
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 1:51 CROSS HILL RD
Mailing Address - Street 2:
Mailing Address - City:CAPE ELIZABETH
Mailing Address - State:ME
Mailing Address - Zip Code:04107-5110
Mailing Address - Country:US
Mailing Address - Phone:207-221-5188
Mailing Address - Fax:207-221-5189
Practice Address - Street 1:69 FEDERAL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-4260
Practice Address - Country:US
Practice Address - Phone:207-221-5188
Practice Address - Fax:207-221-5189
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS844103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical