Provider Demographics
NPI:1013122175
Name:REHAGEN, NICHOLAS J (PHD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:J
Last Name:REHAGEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 ANDROSCOGGIN BLFS
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE FALLS
Mailing Address - State:ME
Mailing Address - Zip Code:04254-4020
Mailing Address - Country:US
Mailing Address - Phone:207-897-5488
Mailing Address - Fax:207-897-4029
Practice Address - Street 1:2 PINE AVE
Practice Address - Street 2:
Practice Address - City:LIVERMORE FALLS
Practice Address - State:ME
Practice Address - Zip Code:04254-1330
Practice Address - Country:US
Practice Address - Phone:207-897-5488
Practice Address - Fax:207-897-4029
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME347103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical