Provider Demographics
NPI:1700195831
Name:DOUYARD, MARY LYNN
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LYNN
Last Name:DOUYARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 108
Mailing Address - Street 2:
Mailing Address - City:EAST BALDWIN
Mailing Address - State:ME
Mailing Address - Zip Code:04024-0108
Mailing Address - Country:US
Mailing Address - Phone:207-637-3546
Mailing Address - Fax:
Practice Address - Street 1:378 PEQUAWKET LAKE RD.
Practice Address - Street 2:
Practice Address - City:LIMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04049
Practice Address - Country:US
Practice Address - Phone:207-637-3546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME212930000OtherMAINE CARE PROVIDER NUMBER