Healthcare Provider Details

I. General information

NPI: 1346555760
Provider Name (Legal Business Name): PAULINE M PINKOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2010
Last Update Date: 08/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 BEACH ST
SACO ME
04072-2812
US

IV. Provider business mailing address

90 BEACH ST
SACO ME
04072-2812
US

V. Phone/Fax

Practice location:
  • Phone: 207-284-4505
  • Fax: 207-284-5951
Mailing address:
  • Phone: 207-284-4505
  • Fax: 207-284-5951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberPE824
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: