MEDICARE: DR. BARBARA J. MCKIM PH.D.

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	PS648	ME
2	103T00000X	Psychologist	PS648	ME
3	103TB0200X	Cognitive & Behavioral Psychologist	PS648	ME
4	103TC0700X	Clinical Psychologist	PS648	ME
5	103TC2200X	Clinical Child & Adolescent Psychologist	PS648	ME
6	103TM1800X	Intellectual & Developmental Disabilities Psychologist	PS648	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	069672	OTHER	VALUEOPTIONS
2	003588	OTHER	ANTHEM
3	5031229	OTHER	AETNA

General Provider Information

NPI Number	:	1740405174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARBARA J. MCKIM PH.D.

Provider Business Mailing Address
First Line	:	57 EXCHANGE ST
Second Line	:	SUITE # 402
City	:	PORTLAND
State	:	ME
Zip	:	04101-5000
Country	:	US
Telephone Number	:	207-774-9615
Fax Number	:

Provider Business Practice Location Address
First Line	:	57 EXCHANGE ST
Second Line	:	SUITE # 402
City	:	PORTLAND
State	:	ME
Zip	:	04101-5000
Country	:	US
Telephone Number	:	207-774-9615
Fax Number	:

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

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	09/11/2025

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