Healthcare Provider Details

I. General information

NPI: 1538076450
Provider Name (Legal Business Name): NORTHEAST PSYCHOLOGY & ASSESSMENT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 GOULD RD
ORONO ME
04473-3038
US

IV. Provider business mailing address

109 GOULD RD
ORONO ME
04473-3038
US

V. Phone/Fax

Practice location:
  • Phone: 617-444-9485
  • Fax:
Mailing address:
  • Phone: 617-444-9485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KATRINA M DAIGLE BORDEN
Title or Position: FOUNDER, CLINICAL PSYCHOLOGIST
Credential: PHD
Phone: 617-444-9485