Organization
MIDLANDS NEUROBEHAVIORAL SERVICES, LLC
Active
Other names
NPACT
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHAWNA BLAKE KIRBY PHD (CLINICAL PSYCHOLOGIST)
(207) 307-7860
Entity
Organization
Contact information
Practice address
621 HAMMOND ST STE 4, BANGOR, ME 04401-4586
(207) 307-7860
(888) 352-7678
Mailing address
621 HAMMOND ST STE 4, BANGOR, ME 04401-4586
(207) 307-7860
(888) 352-7678
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
1251
SC
103G00000X
Clinical Neuropsychologist
Primary
—
—
103T00000X
Psychologist
1251
SC
103T00000X
Psychologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
METPID014444
—
ME
05
—
PS0613
—
SC
01
—
PS2529
LICENCE
ME
01
—
PSY1251
LICENSE
SC
Enumeration date
10/02/2016
Last updated
10/28/2025
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