Provider Demographics
NPI:1548207525
Name:DEERING, CHRISTINE ROSE (PHD)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:ROSE
Last Name:DEERING
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 1:58 HERSEY RD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:ME
Mailing Address - Zip Code:04666-4306
Mailing Address - Country:US
Mailing Address - Phone:207-726-4007
Mailing Address - Fax:207-726-4007
Practice Address - Street 1:58 HERSEY RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:ME
Practice Address - Zip Code:04666-4306
Practice Address - Country:US
Practice Address - Phone:207-726-4007
Practice Address - Fax:207-726-4007
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1003103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
042728OtherANTHEM
DEMM8981Medicare ID - Type Unspecified