| Organization Name: | ANXIETY SOLUTIONS OF NORTHERN NEW ENGLAND, P.L.L.C. |
| NPI Number: | 1366513897 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GORDON POWELL STREET (BUSINESS MANAGER) |
| Mailing Address: | 104 Webbs Mills Rd Raymond |
| State: | ME US |
| Postal Code: | 040716316 |
| Phone Number: | 2076552737 |
| Fax Number: | 2076551065 |
| NPI Enumeration Date: | 11/13/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PS1176 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | ME |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |