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NPI Code Detail

MEDICARE: DR. TERESA M MAYO M.ED, PSYD

MEDICARE: DR. TERESA M MAYO M.ED, PSYD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical PsychologistPS 1000ME

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MM8715OTHERMEPIN

General Provider Information

NPI Number : 1013987403
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TERESA M MAYO M.ED, PSYD
Provider Business Mailing Address
First Line : 89 WILLIAMSON RD
Second Line :
City : MANCHESTER
State : ME
Zip : 04351-3807
Country : US
Telephone Number : 207-215-3488
Fax Number :
Provider Business Practice Location Address
First Line : 250 ARSENAL ST
Second Line : 11 SHS
City : AUGUSTA
State : ME
Zip : 04333-0001
Country : US
Telephone Number : 207-624-4664
Fax Number : 207-287-6123
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2006
Last Update Date : 03/02/2015

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