Healthcare Provider Details

I. General information

NPI: 1366745556
Provider Name (Legal Business Name): MARIA RHEAUME PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2010
Last Update Date: 05/27/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 ST PATRICK PL
PORT HENRY NY
12974-1200
US

IV. Provider business mailing address

PO BOX 493
ELIZABETHTOWN NY
12932-0493
US

V. Phone/Fax

Practice location:
  • Phone: 518-546-7151
  • Fax: 518-546-3785
Mailing address:
  • Phone: 321-474-5861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License NumberNA
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number021832-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: