Healthcare Provider Details

I. General information

NPI: 1033439435
Provider Name (Legal Business Name): MARK WILLIAM STEEGE PSYCHOLOGIST, BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2010
Last Update Date: 06/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 CENTER ST
AUBURN ME
04210-6404
US

IV. Provider business mailing address

2 BELMONT TER
GORHAM ME
04038-1436
US

V. Phone/Fax

Practice location:
  • Phone: 207-782-2726
  • Fax:
Mailing address:
  • Phone: 207-222-2402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS698
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-06-3004
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: