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General NPI Number Information
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NPI Number | 1528398104
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Entity Type | Individual
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Provider Name | BEATA ANNA WIKTOR PSY.D
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Gender | Female
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Dates
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Enumeration Date | 01/05/2010
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Last Update Date | 03/26/2019
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Provider Practice Location Address
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Address Line | 6 MAINE STREET SUITE 1
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City | GRAY
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State | ME
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Zip | 04039
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Country | US
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Telephone | 207-657-8311
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 2074
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City | AUBURN
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State | ME
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Zip | 04211
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Country | US
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Telephone | 207-657-8311
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Fax | 207-221-1496
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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 | PS1417
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License Number State | ME
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