Healthcare Provider Details

I. General information

NPI: 1871658294
Provider Name (Legal Business Name): VAUGHN A HARDESTY PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 PLEASANT ST
PORTLAND ME
04101-3912
US

IV. Provider business mailing address

32 PLEASANT ST
PORTLAND ME
04101-3912
US

V. Phone/Fax

Practice location:
  • Phone: 207-828-5309
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPS 204
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS 204
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPS 204
License Number StateME
# 4
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPS 204
License Number StateME
# 5
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License NumberPS 204
License Number StateME
# 6
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS 204
License Number StateME
# 7
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberPS 204
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: