Healthcare Provider Details

I. General information

NPI: 1558678425
Provider Name (Legal Business Name): EVENTUS MAINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2010
Last Update Date: 09/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 LISBON ST
LEWISTON ME
04240-5059
US

IV. Provider business mailing address

68 PLEASANT ST
BRUNSWICK ME
04011-2203
US

V. Phone/Fax

Practice location:
  • Phone: 207-782-7720
  • Fax: 207-333-3232
Mailing address:
  • Phone: 207-782-7720
  • Fax: 207-333-3232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM M BARTER
Title or Position: OWNER
Credential: PH.D.
Phone: 207-782-7720