Provider Demographics
NPI:1134769391
Name:LAGOM PSYCHOLOGY, PLLC
Entity type:Organization
Organization Name:LAGOM PSYCHOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:ELISABETH
Authorized Official - Last Name:PALMGREN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:207-409-6626
Mailing Address - Street 1:106 LAFAYETTE ST STE 2B
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-6125
Mailing Address - Country:US
Mailing Address - Phone:207-409-6626
Mailing Address - Fax:
Practice Address - Street 1:106 LAFAYETTE ST STE 2B
Practice Address - Street 2:
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-6125
Practice Address - Country:US
Practice Address - Phone:207-409-6626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty