Individual
DR. MARY E FOGG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
131 CHADWICK STREET, PORTLAND, ME 04102
(207) 662-4389
(207) 662-4389
Mailing address
45 LADY'S SLIPPER WAY, GORHAM, ME 04038
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS550
ME
Other
Enumeration date
10/03/2006
Last updated
12/15/2008
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