Provider Demographics
NPI:1831152180
Name:MAATAOUI, SUSAN LICHTMAN (PHD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LICHTMAN
Last Name:MAATAOUI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:LORRAINE
Other - Last Name:LICHTMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 6783
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-6783
Mailing Address - Country:US
Mailing Address - Phone:207-767-1130
Mailing Address - Fax:
Practice Address - Street 1:1000 SHORE RD
Practice Address - Street 2:BLDG 326
Practice Address - City:CAPE ELIZABETH
Practice Address - State:ME
Practice Address - Zip Code:04107-1916
Practice Address - Country:US
Practice Address - Phone:207-767-1130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS802103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MM869401Medicare PIN
MEMM8694Medicare ID - Type Unspecified