Individual
DR. ANITA LAURETTE GOLLER
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
6 CUMBERLAND ST, BRUNSWICK, ME 04011-1904
(207) 729-3092
Mailing address
6 CUMBERLAND ST, BRUNSWICK, ME 04011-1904
(207) 729-3092
(207) 729-3092
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PS904
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
038660
ANTHEM BCBS PIN
ME
05
—
209210000
—
ME
01
—
7160216
AETNA PIN
ME
Enumeration date
01/20/2006
Last updated
10/24/2018
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