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General NPI Number Information
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NPI Number | 1134769391
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Entity Type | Organization
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Legal Business Name | LAGOM PSYCHOLOGY, PLLC
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Dates
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Enumeration Date | 01/15/2020
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Last Update Date | 01/15/2020
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Provider Practice Location Address
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Address Line | 106 LAFAYETTE ST STE 2B
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City | YARMOUTH
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State | ME
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Zip | 04096-6125
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Country | US
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Telephone | 207-409-6626
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Fax |
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Provider Business Mailing Address
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Address Line | 106 LAFAYETTE ST STE 2B
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City | YARMOUTH
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State | ME
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Zip | 04096-6125
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Country | US
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Telephone | 207-409-6626
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. SUSAN ELISABETH PALMGREN
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Credential | PHD
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Telephone | 207-409-6626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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