Provider Demographics
NPI:1184774937
Name:ATTFIELD, MELVYN E (PHD)
Entity type:Individual
Prefix:MR
First Name:MELVYN
Middle Name:E
Last Name:ATTFIELD
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 1:225 COMMERCIAL STREET
Mailing Address - Street 2:SUITE #303
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101
Mailing Address - Country:US
Mailing Address - Phone:207-828-4605
Mailing Address - Fax:207-828-4614
Practice Address - Street 1:225 COMMERCIAL STREET
Practice Address - Street 2:SUITE #303
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101
Practice Address - Country:US
Practice Address - Phone:207-828-4605
Practice Address - Fax:207-828-4614
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS467103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
703778Medicare ID - Type Unspecified