Organization
PSYCHODIAGNOSTIC SERVICES OF SOUTHERN MAINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY CARBONE (CHIEF OFFICER)
(207) 828-4026
Entity
Organization
Contact information
Practice address
491 STEVENS AVE, PORTLAND, ME 04103-2636
(207) 828-4026
Mailing address
491 STEVENS AVE, PORTLAND, ME 04103-2636
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Enumeration date
06/03/2008
Last updated
06/03/2008
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