MEDICARE: MS. CHRISTINE ROSE DEERING PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	PS1003	ME
2	103T00000X	Psychologist	PS1003	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	042728	OTHER		ANTHEM

General Provider Information

NPI Number	:	1548207525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHRISTINE ROSE DEERING PHD

Provider Business Mailing Address
First Line	:	58 HERSEY RD
Second Line	:
City	:	PEMBROKE
State	:	ME
Zip	:	04666-4306
Country	:	US
Telephone Number	:	207-726-4007
Fax Number	:	207-726-4007

Provider Business Practice Location Address
First Line	:	58 HERSEY RD
Second Line	:
City	:	PEMBROKE
State	:	ME
Zip	:	04666-4306
Country	:	US
Telephone Number	:	207-726-4007
Fax Number	:	207-726-4007

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	09/11/2025

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