Healthcare Provider Details

I. General information

NPI: 1811374523
Provider Name (Legal Business Name): RAMONA PANICI PHD LLC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2015
Last Update Date: 04/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 THUNDER RD
NORTH YARMOUTH ME
04097-6100
US

IV. Provider business mailing address

27 THUNDER RD
NORTH YARMOUTH ME
04097-6100
US

V. Phone/Fax

Practice location:
  • Phone: 207-829-2152
  • Fax: 844-839-4800
Mailing address:
  • Phone: 207-829-2152
  • Fax: 844-839-4800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS1129
License Number StateME

VIII. Authorized Official

Name: RAMONA PANICI
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 207-829-2152