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NPI Code Detail

MEDICARE: DR. SUSAN LICHTMAN MAATAOUI PH.D.

MEDICARE:  DR. SUSAN LICHTMAN MAATAOUI  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
1103TC0700XClinical PsychologistPS802ME

General Provider Information

NPI Number : 1831152180
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SUSAN LICHTMAN MAATAOUI PH.D.
Provider Business Mailing Address
First Line : PO BOX 6783
Second Line :
City : PORTLAND
State : ME
Zip : 04103-6783
Country : US
Telephone Number : 207-767-1130
Fax Number :
Provider Business Practice Location Address
First Line : 1000 SHORE RD
Second Line : BLDG 326
City : CAPE ELIZABETH
State : ME
Zip : 04107-1916
Country : US
Telephone Number : 207-767-1130
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/08/2006
Last Update Date : 09/11/2012

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Directions to “ DR. SUSAN LICHTMAN MAATAOUI PH.D.” Practice Location

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