Healthcare Provider Details

I. General information

NPI: 1427370014
Provider Name (Legal Business Name): SUSAN WALDRON NEWKIRK-SANBORN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2010
Last Update Date: 02/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 ARSENAL ST. 11 STATE HOUSE STATION
AUGUSTA ME
04333-0011
US

IV. Provider business mailing address

250 ARSENAL ST. 11 STATE HOUSE STATION
AUGUSTA ME
04333-0011
US

V. Phone/Fax

Practice location:
  • Phone: 207-624-3961
  • Fax: 207-287-6123
Mailing address:
  • Phone: 207-624-4657
  • Fax: 207-287-6123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS377
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: