Individual
DAVID C LILLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
174 S FREEPORT RD # 2E, FREEPORT, ME 04032-6145
(207) 865-9692
(207) 865-9241
Mailing address
174 S FREEPORT RD # 2E, FREEPORT, ME 04032-6145
(207) 865-9692
(207) 865-9241
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PS107
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
039291
ANTHEM
ME
05
—
328740099
—
ME
Enumeration date
02/28/2007
Last updated
07/08/2007
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