Provider Demographics
NPI:1689769994
Name:KAHN, MONIQUE RICHARD (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MONIQUE
Middle Name:RICHARD
Last Name:KAHN
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 1:108 MAIN RD S
Mailing Address - Street 2:
Mailing Address - City:HAMPDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04444-1204
Mailing Address - Country:US
Mailing Address - Phone:207-862-2899
Mailing Address - Fax:
Practice Address - Street 1:108 MAIN RD S
Practice Address - Street 2:
Practice Address - City:HAMPDEN
Practice Address - State:ME
Practice Address - Zip Code:04444-1204
Practice Address - Country:US
Practice Address - Phone:207-862-2899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2008-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1005103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME047300OtherANTHEM BLUE CROSS BL SHLD