Healthcare Provider Details

I. General information

NPI: 1740269190
Provider Name (Legal Business Name): EDWIN RONALD FEINTECH PHD PSYCHOLOGY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: EDWIN R FEINTECH MD

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 GRAYSTONE RD
GRAY ME
04039-7517
US

IV. Provider business mailing address

15 GRAYSTONE RD
GRAY ME
04039-7517
US

V. Phone/Fax

Practice location:
  • Phone: 207-415-2908
  • Fax:
Mailing address:
  • Phone: 207-415-5290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS572
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: