Healthcare Provider Details

I. General information

NPI: 1851576862
Provider Name (Legal Business Name): BRENT DAVID ELWOOD PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 01/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 CUTLER HEALTH CENTER UNIVERSITY OF MAINE
ORONO ME
04469-5721
US

IV. Provider business mailing address

125 CUTLER HEALTH CENTER UNIVERSITY OF MAINE
ORONO ME
04469-5721
US

V. Phone/Fax

Practice location:
  • Phone: 207-581-1392
  • Fax: 207-581-4975
Mailing address:
  • Phone: 207-581-1392
  • Fax: 207-581-4975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPS1100
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberPS1100
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: