Provider Demographics
NPI:1255722534
Name:BEHREM, NADIR (PSYD)
Entity type:Individual
Prefix:
First Name:NADIR
Middle Name:
Last Name:BEHREM
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 QUARRY RD
Mailing Address - Street 2:APT. 37
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4964
Mailing Address - Country:US
Mailing Address - Phone:262-664-3658
Mailing Address - Fax:
Practice Address - Street 1:26 QUARRY RD
Practice Address - Street 2:APT. 37
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4964
Practice Address - Country:US
Practice Address - Phone:262-664-3658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1436103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical