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General NPI Number Information
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NPI Number | 1578548871
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Entity Type | Individual
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Provider Name | CAROLYN CRISS MD
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Gender | Female
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Dates
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Enumeration Date | 12/08/2005
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Last Update Date | 11/19/2013
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Provider Practice Location Address
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Address Line | 8 PAGE ST
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City | AUGUSTA
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State | ME
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Zip | 04330-6805
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Country | US
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Telephone | 207-623-7543
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 158
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City | AUGUSTA
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State | ME
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Zip | 04332-0158
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Country | US
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Telephone | 207-623-7543
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Fax |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | TD05052
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License Number State | ME
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