Provider Demographics
NPI:1437753290
Name:DRAGONFLY PSYCHOLOGICAL SERVICES LLC
Entity Type:Organization
Organization Name:DRAGONFLY PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDARIS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:207-358-9607
Mailing Address - Street 1:9 BOWDOIN MILL IS
Mailing Address - Street 2:
Mailing Address - City:TOPSHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04086-1263
Mailing Address - Country:US
Mailing Address - Phone:207-358-9607
Mailing Address - Fax:352-206-7207
Practice Address - Street 1:9 BOWDOIN MILL IS
Practice Address - Street 2:
Practice Address - City:TOPSHAM
Practice Address - State:ME
Practice Address - Zip Code:04086-1263
Practice Address - Country:US
Practice Address - Phone:207-358-9607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-23
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty