Individual
GLEN E DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
14 STONEWALL WAY, FALMOUTH, ME 04105-2491
(207) 221-2631
(866) 611-6717
Mailing address
14 STONEWALL WAY, FALMOUTH, ME 04105-2491
(207) 221-2631
(866) 611-6717
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS593
ME
103TC2200X
Clinical Child & Adolescent Psychologist
PS593
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
154420000
—
ME
Enumeration date
06/12/2006
Last updated
02/17/2022
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