Provider Demographics
NPI:1851483556
Name:CUDDY, MARY ELIZABETH (PHD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:CUDDY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 COLUMBIA ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6355
Mailing Address - Country:US
Mailing Address - Phone:207-990-2115
Mailing Address - Fax:
Practice Address - Street 1:15 COLUMBIA ST
Practice Address - Street 2:SUITE 302
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6355
Practice Address - Country:US
Practice Address - Phone:207-990-2115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS789103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME038037OtherANTHEM INSURANCE