Healthcare Provider Details

I. General information

NPI: 1639858186
Provider Name (Legal Business Name): THOMAS MICHAEL MEUSER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2023
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1582 WASHINGTON AVE
PORTLAND ME
04103-2023
US

IV. Provider business mailing address

PO BOX 11193
PORTLAND ME
04104-7193
US

V. Phone/Fax

Practice location:
  • Phone: 131-440-2863
  • Fax:
Mailing address:
  • Phone: 207-331-4336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPS2520
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: