MEDICARE: ANN M CHRISTIE PC

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
1	103TC0700X	Clinical Psychologist	PSY002054	GA
2	103TC0700X	Clinical Psychologist	PY 5524	FL
3	103TC0700X	Clinical Psychologist	PS1197	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	461740	OTHER	GA	VALUE OPTIONS
2	10751280	OTHER	ME	CAQH
3	200300	OTHER	ME	ANTHEM BC/BS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639397664
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANN M CHRISTIE PC

Provider Business Mailing Address
First Line	:	57 EXCHANGE ST
Second Line	:	SUITE 403
City	:	PORTLAND
State	:	ME
Zip	:	04101-5000
Country	:	US
Telephone Number	:	207-774-6300
Fax Number	:	207-775-4454

Provider Business Practice Location Address
First Line	:	57 EXCHANGE ST
Second Line	:	SUITE 403
City	:	PORTLAND
State	:	ME
Zip	:	04101-5000
Country	:	US
Telephone Number	:	207-774-6300
Fax Number	:	207-775-4454

Authorized Official
Title or Position	:	PRESIDENT OWNER
Name	:	ANN CHRISTIE
Credential	:	PSYD
Telephone Number	:	207-774-6300

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	06/28/2010

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Directions to “ANN M CHRISTIE PC ” Practice Location

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