Provider Demographics
NPI:1679681217
Name:CHANDLER, REBECCA (PMHNP CS)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:PMHNP CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 FRANKLIN HEALTH CMNS
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04938-6144
Mailing Address - Country:US
Mailing Address - Phone:207-778-0035
Mailing Address - Fax:207-778-6879
Practice Address - Street 1:131 FRANKLIN HEALTH CMNS
Practice Address - Street 2:STE A
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938-6142
Practice Address - Country:US
Practice Address - Phone:207-778-0035
Practice Address - Fax:207-778-6879
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER033605363LP0808X
MEASO84132364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431894799Medicaid
MEMC1357551OtherDEA
MENS8091Medicare ID - Type Unspecified
Q18678Medicare UPIN