Doctor Name: | DR. KENNETH A. BEATTIE |
NPI Number: | 1023032869 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PH.D. |
License Number: | PS1018 |
Business Practice Address: | 64 Church St Ellsworth, ME - 046051658 |
Business Phone Number: | 2076696011 |
Business Fax Number: | 2076696011 |
Mailing Address: | 94 Mill St, ORONO |
State: | ME |
Postal Code: | 044734040 |
Phone Number: | 2076696011 |
Fax Number: | 2076696011 |
NPI Enumeration Date: | 07/26/2006 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | PS1018 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ME |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |