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General NPI Number Information
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NPI Number | 1982373320
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Entity Type | Individual
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Provider Name | KEVIN PACIFICO TAPP GONZAGA PHD
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Gender | Male
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Dates
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Enumeration Date | 09/09/2021
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 14 MAINE ST STE 309
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City | BRUNSWICK
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State | ME
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Zip | 04011-2033
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Country | US
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Telephone | 76-074-0222
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Fax |
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Provider Business Mailing Address
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Address Line | 14 MAINE ST STE 309
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City | BRUNSWICK
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State | ME
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Zip | 04011-2033
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Country | US
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Telephone | 207-607-4022
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS2607
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License Number State | ME
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