Provider Demographics
NPI:1689064511
Name:BEATA A WIKTOR, INC
Entity Type:Organization
Organization Name:BEATA A WIKTOR, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BEATA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WIKTOR
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:207-200-5925
Mailing Address - Street 1:PO BOX 1614
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-1614
Mailing Address - Country:US
Mailing Address - Phone:207-200-5925
Mailing Address - Fax:
Practice Address - Street 1:6 MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:GRAY
Practice Address - State:ME
Practice Address - Zip Code:04039-9502
Practice Address - Country:US
Practice Address - Phone:207-657-8311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1417103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty