Provider Demographics
NPI:1467588608
Name:ZUBROD, LOUISE A (EDD MAINE PSYCHOLO)
Entity Type:Individual
Prefix:DR
First Name:LOUISE
Middle Name:A
Last Name:ZUBROD
Suffix:
Gender:F
Credentials:EDD MAINE PSYCHOLO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 PINE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-3841
Mailing Address - Country:US
Mailing Address - Phone:207-774-5741
Mailing Address - Fax:207-772-4322
Practice Address - Street 1:345 COTTAGE RD
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106
Practice Address - Country:US
Practice Address - Phone:207-774-5741
Practice Address - Fax:207-772-4322
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS506103TC0700X
ME506103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME270680099Medicaid
ME117140000Medicaid
ME026804OtherANTHEM
ME270680099Medicaid
MEMM3512Medicare PIN