Healthcare Provider Details

I. General information

NPI: 1629142435
Provider Name (Legal Business Name): EMILY TARBET SIEGEL PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY MERRILL TARBET PSYD

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 05/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1577 CONGRESS ST 2ND FLOOR
PORTLAND ME
04102-2169
US

IV. Provider business mailing address

301 US ROUTE 1 BUILDING C
SCARBOROUGH ME
04074-9701
US

V. Phone/Fax

Practice location:
  • Phone: 207-662-1622
  • Fax: 207-774-1814
Mailing address:
  • Phone: 207-396-8600
  • Fax: 207-396-8632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS00865
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS1280
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: