Healthcare Provider Details

I. General information

NPI: 1215811328
Provider Name (Legal Business Name): LISA HUBERT-FOX PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 ANDOVER RD
WESTBROOK ME
04092-3848
US

IV. Provider business mailing address

3 FOLSOM DR
BIDDEFORD ME
04005-9748
US

V. Phone/Fax

Practice location:
  • Phone: 207-761-2200
  • Fax:
Mailing address:
  • Phone: 207-229-2149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP251299
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: