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General NPI Number Information
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NPI Number | 1689064511
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Entity Type | Organization
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Legal Business Name | BEATA A WIKTOR, INC
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Dates
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Enumeration Date | 01/30/2015
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Last Update Date | 01/30/2015
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Provider Practice Location Address
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Address Line | 6 MAIN ST SUITE 1
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City | GRAY
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State | ME
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Zip | 04039-9502
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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 | PO BOX 1614
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City | WINDHAM
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State | ME
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Zip | 04062-1614
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Country | US
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Telephone | 207-200-5925
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BEATA A WIKTOR
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Credential | PSYD
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Telephone | 207-200-5925
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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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