Healthcare Provider Details

I. General information

NPI: 1326054123
Provider Name (Legal Business Name): JEROLD E HAMBRIGHT PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VA CENTER TOGUS VA MEDICAL CENTER
AUGUSTA ME
04330
US

IV. Provider business mailing address

37 TURTLE RUN RD # U-21
WINTHROP ME
04364-3083
US

V. Phone/Fax

Practice location:
  • Phone: 207-623-8411
  • Fax:
Mailing address:
  • Phone: 207-395-4754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPS713
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: