Provider Demographics
NPI:1245395532
Name:CURLESS, MICHAEL WILLIAM (PHD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:WILLIAM
Last Name:CURLESS
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:PO BOX 420
Mailing Address - Street 2:
Mailing Address - City:MOUNT DESERT
Mailing Address - State:ME
Mailing Address - Zip Code:04660-0420
Mailing Address - Country:US
Mailing Address - Phone:207-667-3485
Mailing Address - Fax:207-412-0043
Practice Address - Street 1:24 BIRCH AVE STE A
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1804
Practice Address - Country:US
Practice Address - Phone:207-667-3485
Practice Address - Fax:207-412-0043
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1055103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME044921OtherANTHEM
ME338030099Medicaid