Provider Demographics
NPI:1679694129
Name:ROUGH, JAMES H (PSYD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:H
Last Name:ROUGH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 COMMERCIAL ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-4613
Mailing Address - Country:US
Mailing Address - Phone:207-771-2001
Mailing Address - Fax:207-771-2001
Practice Address - Street 1:225 COMMERCIAL ST
Practice Address - Street 2:SUITE 401
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-4613
Practice Address - Country:US
Practice Address - Phone:207-771-2001
Practice Address - Fax:207-771-2001
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1087103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME115243OtherMARTINS POINT
ME7096738OtherAETNA
ME047373OtherANTHEM