Provider Demographics
NPI:1184816357
Name:STEMPEL, AUDREY DONNA (PHD)
Entity type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:DONNA
Last Name:STEMPEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 GRAY AVE
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-3326
Mailing Address - Country:US
Mailing Address - Phone:207-838-0512
Mailing Address - Fax:207-283-0064
Practice Address - Street 1:636 US ROUTE 1
Practice Address - Street 2:SUITE B
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-9700
Practice Address - Country:US
Practice Address - Phone:207-205-0289
Practice Address - Fax:207-883-3144
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1217103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical