Healthcare Provider Details

I. General information

NPI: 1255564571
Provider Name (Legal Business Name): SUSAN HOLINGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2009
Last Update Date: 09/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 LENFESTY LN
BELGRADE ME
04917-3718
US

IV. Provider business mailing address

20 LENFESTY LN
BELGRADE ME
04917-3718
US

V. Phone/Fax

Practice location:
  • Phone: 207-495-3331
  • Fax:
Mailing address:
  • Phone: 207-495-3331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License NumberPE862
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: