Provider Demographics
NPI:1497904569
Name:GREGORY W. NEVENS, ED.D PA
Entity Type:Organization
Organization Name:GREGORY W. NEVENS, ED.D PA
Other - Org Name:HEALTH PSYCHOLOGY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:W
Authorized Official - Last Name:NEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:EDD,
Authorized Official - Phone:207-653-4301
Mailing Address - Street 1:PO BOX 854
Mailing Address - Street 2:
Mailing Address - City:ALFRED
Mailing Address - State:ME
Mailing Address - Zip Code:04002-0854
Mailing Address - Country:US
Mailing Address - Phone:207-415-1881
Mailing Address - Fax:207-699-3831
Practice Address - Street 1:222 AUBURN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-6002
Practice Address - Country:US
Practice Address - Phone:207-653-4301
Practice Address - Fax:207-699-3831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-15
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME00617103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Single Specialty