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General NPI Number Information
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NPI Number | 1215081930
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Entity Type | Individual
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Provider Name | MICHAEL AXELROD PHD
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Gender | Male
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 08/01/2008
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Provider Practice Location Address
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Address Line | 268 SILLWATER AVENUE ACADIA HOSPITAL CORP.
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City | BANGOR
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State | ME
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Zip | 04401
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Country | US
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Telephone | 207-973-6100
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Fax | 207-973-6109
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Provider Business Mailing Address
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Address Line | P.O. BOX 422 ACADIA HOSPITAL CORP.
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City | BANGOR
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State | ME
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Zip | 04402-0422
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Country | US
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Telephone | 207-973-6100
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Fax | 207-973-6109
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 606
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS1237
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License Number State | ME
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