Provider Demographics
NPI:1639397664
Name:ANN M CHRISTIE PC
Entity type:Organization
Organization Name:ANN M CHRISTIE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTIE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:207-774-6300
Mailing Address - Street 1:57 EXCHANGE ST
Mailing Address - Street 2:SUITE 403
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-5000
Mailing Address - Country:US
Mailing Address - Phone:207-774-6300
Mailing Address - Fax:207-775-4454
Practice Address - Street 1:57 EXCHANGE ST
Practice Address - Street 2:SUITE 403
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-5000
Practice Address - Country:US
Practice Address - Phone:207-774-6300
Practice Address - Fax:207-775-4454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002054103TC0700X
FLPY 5524103TC0700X
MEPS1197103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA461740OtherVALUE OPTIONS
ME10751280OtherCAQH
ME200300OtherANTHEM BC/BS
ME432779400Medicaid
GA000741584AMedicaid
GA000741584AMedicaid