Healthcare Provider Details

I. General information

NPI: 1013987403
Provider Name (Legal Business Name): TERESA M MAYO M.ED, PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 03/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 ARSENAL ST 11 SHS
AUGUSTA ME
04333-0001
US

IV. Provider business mailing address

89 WILLIAMSON RD
MANCHESTER ME
04351-3807
US

V. Phone/Fax

Practice location:
  • Phone: 207-624-4664
  • Fax: 207-287-6123
Mailing address:
  • Phone: 207-215-3488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS 1000
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: