Healthcare Provider Details

I. General information

NPI: 1497246870
Provider Name (Legal Business Name): KEVIN CARL DAVID PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 MAINE ST STE 309
BRUNSWICK ME
04011-2033
US

IV. Provider business mailing address

14 MAINE ST STE 309
BRUNSWICK ME
04011-2033
US

V. Phone/Fax

Practice location:
  • Phone: 207-607-4022
  • Fax:
Mailing address:
  • Phone: 207-607-4022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS2703
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: