Provider Demographics
NPI:1851576862
Name:ELWOOD, BRENT DAVID (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:DAVID
Last Name:ELWOOD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:125 CUTLER HEALTH CENTER
Mailing Address - Street 2:UNIVERSITY OF MAINE
Mailing Address - City:ORONO
Mailing Address - State:ME
Mailing Address - Zip Code:04469-5721
Mailing Address - Country:US
Mailing Address - Phone:207-581-1392
Mailing Address - Fax:207-581-4975
Practice Address - Street 1:125 CUTLER HEALTH CENTER
Practice Address - Street 2:UNIVERSITY OF MAINE
Practice Address - City:ORONO
Practice Address - State:ME
Practice Address - Zip Code:04469-5721
Practice Address - Country:US
Practice Address - Phone:207-581-1392
Practice Address - Fax:207-581-4975
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1100103TC1900X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy