Healthcare Provider Details

I. General information

NPI: 1700964749
Provider Name (Legal Business Name): ERIN L. BELFORT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIN E LECHNER

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 BRAMHALL STREET
PORTLAND ME
04102-3344
US

IV. Provider business mailing address

25 MIDDLE ST
PORTLAND ME
04101-4869
US

V. Phone/Fax

Practice location:
  • Phone: 207-662-3101
  • Fax: 207-662-6783
Mailing address:
  • Phone: 207-705-3676
  • Fax: 207-705-3677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD19358
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number234661
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD19358
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: