Provider Demographics
NPI:1851332613
Name:HASSLER, AMELIA ANN (PSYD)
Entity Type:Individual
Prefix:MS
First Name:AMELIA
Middle Name:ANN
Last Name:HASSLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MRS
Other - First Name:AMELIA
Other - Middle Name:HASSLER
Other - Last Name:ARDISSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:PO BOX 10018
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04104-0018
Mailing Address - Country:US
Mailing Address - Phone:207-450-3625
Mailing Address - Fax:313-672-6160
Practice Address - Street 1:93 RIVERS EDGE DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-1952
Practice Address - Country:US
Practice Address - Phone:207-450-3625
Practice Address - Fax:313-672-6160
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2014-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1170103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431891500Medicaid
MEME1783Medicare ID - Type Unspecified