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NPI Code Detail

MEDICARE: STACY WHITCOMB-SMITH PHD

MEDICARE: STACY WHITCOMB-SMITH PHD
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 PsychologistPS1158ME

General Provider Information

NPI Number : 1396769642
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACY WHITCOMB-SMITH PHD
Provider Business Mailing Address
First Line : 66 STONE ST
Second Line :
City : AUGUSTA
State : ME
Zip : 04330-5227
Country : US
Telephone Number : 207-626-3455
Fax Number : 207-626-3612
Provider Business Practice Location Address
First Line : 66 STONE ST
Second Line :
City : AUGUSTA
State : ME
Zip : 04330-5227
Country : US
Telephone Number : 207-626-3455
Fax Number : 207-626-3612
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2006
Last Update Date : 07/08/2007

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Directions to “ STACY WHITCOMB-SMITH PHD” Practice Location

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