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General NPI Number Information
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NPI Number | 1760807200
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Entity Type | Organization
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Legal Business Name | MINDFUL PATHS PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 02/20/2014
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Last Update Date | 02/20/2014
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Provider Practice Location Address
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Address Line | 883 MAIN ST
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City | SANFORD
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State | ME
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Zip | 04073-3672
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Country | US
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Telephone | 207-351-6719
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 838
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City | YORK
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State | ME
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Zip | 03909-0838
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Country | US
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Telephone | 207-351-6719
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Fax | 207-351-3046
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Authorized Official
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Title or Position | PSYCHOLOGIST/OWNER
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Name | DR. MARY P DONAHUE
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Credential | PH.D.
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Telephone | 207-351-6719
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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 | PS1331
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License Number State | ME
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