Provider Demographics
NPI:1942541321
Name:PRATT, JAMIE LAURA (PSYD, BCBA-D)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:LAURA
Last Name:PRATT
Suffix:
Gender:F
Credentials:PSYD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 DAVENPORT CIR
Mailing Address - Street 2:SUITE 20
Mailing Address - City:BATH
Mailing Address - State:ME
Mailing Address - Zip Code:04530-2880
Mailing Address - Country:US
Mailing Address - Phone:207-522-8878
Mailing Address - Fax:207-443-2807
Practice Address - Street 1:2 DAVENPORT CIR
Practice Address - Street 2:SUITE 20
Practice Address - City:BATH
Practice Address - State:ME
Practice Address - Zip Code:04530-2880
Practice Address - Country:US
Practice Address - Phone:207-522-8878
Practice Address - Fax:207-443-2807
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-08
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1107486103K00000X
MEPS1337103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst