Provider Demographics
NPI:1932237674
Name:FAUST, DOUGLAS STUART (PHD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:STUART
Last Name:FAUST
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12 OLD FARM HL
Mailing Address - Street 2:UNIT 1
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-4396
Mailing Address - Country:US
Mailing Address - Phone:985-778-9834
Mailing Address - Fax:
Practice Address - Street 1:618 MAIN ST
Practice Address - Street 2:NEUROPSYCH TESTING CTR, GOODWILL NEUROREHAB CENTER
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-5935
Practice Address - Country:US
Practice Address - Phone:207-513-5115
Practice Address - Fax:207-513-5116
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA640103G00000X, 103TB0200X, 103T00000X, 103TR0400X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3B254DK63Medicare PIN