Provider Demographics
NPI:1942652656
Name:SLOBODNIK, NANCY
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:SLOBODNIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 HOLLYWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:ALNA
Mailing Address - State:ME
Mailing Address - Zip Code:04535-3038
Mailing Address - Country:US
Mailing Address - Phone:207-350-5103
Mailing Address - Fax:
Practice Address - Street 1:1 VA CTR # 28
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-6719
Practice Address - Country:US
Practice Address - Phone:207-626-4788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1471103TC0700X
NJ#35SI00379800103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical