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General NPI Number Information
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NPI Number | 1366513897
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Entity Type | Organization
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Legal Business Name | ANXIETY SOLUTIONS OF NORTHERN NEW ENGLAND, PLLC
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 01/17/2025
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Provider Practice Location Address
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Address Line | 186 TWIN SPRING LANE
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City | LINCOLN
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State | ME
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Zip | 04457
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Country | US
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Telephone | 207-655-2737
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Fax | 207-655-1065
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Provider Business Mailing Address
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Address Line | PO BOX 70
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City | RAYMOND
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State | ME
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Zip | 04071-0070
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Country | US
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Telephone | 207-655-2737
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Fax | 207-655-1065
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Authorized Official
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Title or Position | CO-OWNER AND BUSINESS MANAGER
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Name | DR. GORDON POWELL STREET
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Credential | PHD
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Telephone | 207-655-2737
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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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