Provider Demographics
NPI:1982772406
Name:POWERS, PAMELA DENISE (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:DENISE
Last Name:POWERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 FOREST FALLS DR
Mailing Address - Street 2:SUITE B-2
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-6999
Mailing Address - Country:US
Mailing Address - Phone:207-846-7800
Mailing Address - Fax:207-846-7756
Practice Address - Street 1:45 FOREST FALLS DR
Practice Address - Street 2:SUITE B-2
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-6999
Practice Address - Country:US
Practice Address - Phone:207-846-7800
Practice Address - Fax:207-846-7756
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS674103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME003443Medicare UPIN
MEMM5457Medicare ID - Type UnspecifiedMEDICARE