Healthcare Provider Details

I. General information

NPI: 1295865921
Provider Name (Legal Business Name): WASHINGTON COUNTY PSYCHOTHERAPY ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 PALMER ST
CALAIS ME
04619-1300
US

IV. Provider business mailing address

PO BOX 29
MACHIAS ME
04654-0029
US

V. Phone/Fax

Practice location:
  • Phone: 207-454-0775
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS532
License Number StateME

VIII. Authorized Official

Name: DR. JOHN EDWARDS
Title or Position: CEO
Credential: PHD
Phone: 207-255-4990