Individual
ELISE C MAGNUSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
251 WOODFORD ST, PORTLAND, ME 04103-5617
(207) 632-6965
(207) 761-8150
Mailing address
251 WOODFORD ST, PORTLAND, ME 04103-5617
(207) 632-6965
(207) 761-8150
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS 1242
ME
1041C0700X
Clinical Social Worker
LC11425
ME
Other
Enumeration date
03/08/2007
Last updated
09/24/2019
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