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General NPI Number Information
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NPI Number | 1770602641
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Entity Type | Individual
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Provider Name | SHAWN R KALBACK PHD
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Gender | Female
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 1577 CONGRESS ST STE 2
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City | PORTLAND
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State | ME
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Zip | 04102-2169
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Country | US
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Telephone | 207-662-5522
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Fax | 207-774-1814
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Provider Business Mailing Address
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Address Line | 1577 CONGRESS ST STE 2
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City | PORTLAND
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State | ME
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Zip | 04102-2169
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Country | US
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Telephone | 207-662-5522
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Fax | 207-774-1814
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS1375
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 04354
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PS1375
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License Number State | ME
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