# MAINE CHILD PSYCHOLOGY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760744601
- **Authorized official:** DR. GLEN DAVIS PH.D. (PSYCHOLOGIST)
- **Authorized official phone:** (207) 221-2631

## Contact information

- **Practice address:** 14 STONEWALL WAY, FALMOUTH, ME 04105-2491
- **Practice address phone:** (207) 221-2631
- **Practice address fax:** (866) 611-6717
- **Mailing address:** 14 STONEWALL WAY, FALMOUTH, ME 04105-2491
- **Mailing address phone:** (207) 221-2631
- **Mailing address fax:** (866) 611-6717

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TC2200X | Clinical Child & Adolescent Psychologist | PS593 | ME | Yes |

## Other

- **Enumeration date:** 06/15/2012
- **Last updated:** 02/22/2022