Individual
ANNIE DERTHICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
76 HIGH ST, LEWISTON, ME 04240
(207) 795-2800
Mailing address
76 HIGH ST, LEWISTON, ME 04240-7649
(207) 795-2800
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
107779
AK
103TF0000X
Family Psychologist
Primary
PS1563
ME
Other
Enumeration date
12/21/2015
Last updated
09/13/2018
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