Provider Demographics
NPI:1497031785
Name:MORTON, BOBBY
Entity type:Individual
Prefix:
First Name:BOBBY
Middle Name:
Last Name:MORTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 WALDOBORO RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:ME
Mailing Address - Zip Code:04348-3922
Mailing Address - Country:US
Mailing Address - Phone:207-242-5726
Mailing Address - Fax:207-512-1028
Practice Address - Street 1:53 BAXTER BLVD STE 3
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-1827
Practice Address - Country:US
Practice Address - Phone:603-883-0005
Practice Address - Fax:603-883-0007
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN52044103TC0700X
MEAP111091363LP0808X
MECNP111091103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health