Provider Demographics
NPI:1619159951
Name:ROBIN L. VEDDER
Entity Type:Organization
Organization Name:ROBIN L. VEDDER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:VEDDER
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:207-342-4130
Mailing Address - Street 1:29 WEYMOUTH RD
Mailing Address - Street 2:HAWTHORNE MEADOWS
Mailing Address - City:MORRILL
Mailing Address - State:ME
Mailing Address - Zip Code:04952-5007
Mailing Address - Country:US
Mailing Address - Phone:207-342-4130
Mailing Address - Fax:207-342-4130
Practice Address - Street 1:29 WEYMOUTH RD
Practice Address - Street 2:HAWTHORNE MEADOWS
Practice Address - City:MORRILL
Practice Address - State:ME
Practice Address - Zip Code:04952-5007
Practice Address - Country:US
Practice Address - Phone:207-342-4130
Practice Address - Fax:207-342-4130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health