Provider Demographics
NPI:1770718876
Name:HAMPDEN PSYCHOLOGICAL CONSULTATION, PLLC
Entity type:Organization
Organization Name:HAMPDEN PSYCHOLOGICAL CONSULTATION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:PRESCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:207-862-3370
Mailing Address - Street 1:108 B MAIN ROAD SOUTH
Mailing Address - Street 2:HAMPDEN PSYCHOLOGICAL CONSULTATION, PLLC
Mailing Address - City:HAMPDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04444
Mailing Address - Country:US
Mailing Address - Phone:207-862-3370
Mailing Address - Fax:207-862-3350
Practice Address - Street 1:108 B MAIN ROAD SOUTH
Practice Address - Street 2:HAMPDEN PSYCHOLOGICAL CONSULTATION, PLLC
Practice Address - City:HAMPDEN
Practice Address - State:ME
Practice Address - Zip Code:04444
Practice Address - Country:US
Practice Address - Phone:207-862-3370
Practice Address - Fax:207-862-3350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty