Individual
MARY ANNE NICOLE ROY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
66 PEARL ST STE 326, PORTLAND, ME 04101-4167
(207) 773-9931
Mailing address
66 PEARL ST STE 326, PORTLAND, ME 04101-4167
(207) 773-9931
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PS1269
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
098304
ANTHEM LEGACY NUMBER
ME
05
—
432502899
—
ME
Enumeration date
03/26/2007
Last updated
09/27/2010
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