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Organization

SOUTHWESTERN MAINE CLINICAL ASSOC PA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. KERRY E KIMBALL EDD (CEO)
(207) 839-2587
Entity
Organization

Contact information

Practice address
20 MECHANIC ST, GORHAM, ME 04038
(207) 839-2587
(207) 839-2022
Mailing address
PO BOX 757, GORHAM, ME 04038-0757
(207) 839-2587
(207) 839-2022

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS574
ME

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
125580000
ME
Enumeration date
02/09/2006
Last updated
04/24/2008
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