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General NPI Number Information
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NPI Number | 1184854630
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Entity Type | Organization
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Legal Business Name | EVENTUS MAINE LLC
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Dates
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Enumeration Date | 07/18/2009
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Last Update Date | 07/18/2009
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Provider Practice Location Address
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Address Line | 1180 LISBON ST
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City | LEWISTON
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State | ME
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Zip | 04240-5059
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Country | US
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Telephone | 207-782-7720
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Fax |
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Provider Business Mailing Address
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Address Line | 68 PLEASANT ST
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City | BRUNSWICK
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State | ME
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Zip | 04011-2203
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Country | US
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Telephone | 207-782-7720
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Fax | 207-333-3232
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Authorized Official
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Title or Position | OWNER
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Name | DR. WILLIAM MARTIN BARTER
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Credential | PH.D.
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Telephone | 207-782-7720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS1141
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License Number State | ME
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