Provider Demographics
NPI:1568686541
Name:CHRISTIE, ANN M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:M
Last Name:CHRISTIE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-5712
Mailing Address - Country:US
Mailing Address - Phone:207-773-7993
Mailing Address - Fax:
Practice Address - Street 1:205 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-5712
Practice Address - Country:US
Practice Address - Phone:207-773-7993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002054103TC0700X
FLPY 5523103TC0700X
103TS0200X
MEPS1197103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000741584AMedicaid
ME200300OtherANTHEM BC/BS
ME432779400Medicaid
ME10751280OtherCAQH
GA461740OtherVALUE OPTIONS
GA582452807OtherFEDERAL TAX ID