Individual
DR. GORDON POWELL STREET
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
175 WEST BROADWAY, LINCOLN, ME 04457
(207) 794-6700
(207) 794-0059
Mailing address
175 WEST BROADWAY, LINCOLN, ME 04457
(207) 794-6700
(207) 794-0059
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PS1177
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
061698
ANTHEM BC/BS OF ME PIN
ME
05
—
061698
—
ME
Enumeration date
02/23/2006
Last updated
03/30/2023
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