Provider Demographics
NPI:1881647949
Name:LOFTUS, DEBORAH W (PHD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:W
Last Name:LOFTUS
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 1:525 NORWAY DR
Mailing Address - Street 2:
Mailing Address - City:BAR HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04609-7757
Mailing Address - Country:US
Mailing Address - Phone:207-288-8111
Mailing Address - Fax:207-288-8111
Practice Address - Street 1:75 STATE ST
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1947
Practice Address - Country:US
Practice Address - Phone:207-460-5879
Practice Address - Fax:207-288-8111
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1093103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEPS1093OtherME LICENSE
ME431585999Medicaid
MEPS1093OtherME LICENSE