Healthcare Provider Details

I. General information

NPI: 1396554481
Provider Name (Legal Business Name): CATHERINE SIERRA STUART PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2025
Last Update Date: 01/02/2025
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 SACO AVE STE 2A
OLD ORCHARD BEACH ME
04064-1623
US

IV. Provider business mailing address

155 SACO AVE STE 2A
OLD ORCHARD BEACH ME
04064-1623
US

V. Phone/Fax

Practice location:
  • Phone: 207-937-8254
  • Fax: 844-824-7835
Mailing address:
  • Phone: 207-937-8254
  • Fax: 844-824-7835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP241740
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: