Healthcare Provider Details

I. General information

NPI: 1124182241
Provider Name (Legal Business Name): JEFFREY SCOTT KREBS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 MAIN STREET
PORTER ME
04068
US

IV. Provider business mailing address

PO BOX 777
PARSONSFIELD ME
04047
US

V. Phone/Fax

Practice location:
  • Phone: 207-625-8126
  • Fax: 207-625-7820
Mailing address:
  • Phone: 207-625-8126
  • Fax: 207-625-7820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberOS922
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number000582
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number004751
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: