Healthcare Provider Details

I. General information

NPI: 1891908695
Provider Name (Legal Business Name): LINDA A. DESHETLER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VA CTR
AUGUSTA ME
04330-6795
US

IV. Provider business mailing address

1 VA CTR
AUGUSTA ME
04330-6795
US

V. Phone/Fax

Practice location:
  • Phone: 207-419-9896
  • Fax:
Mailing address:
  • Phone: 207-419-9896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number6318
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number6318
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6318
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number6318
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number6318
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: