1992870976 NPI number — DR. KIM ROSAN TOUSIGNANT PSY.D.,

Table of content: MS. EVE A ADLER MS (NPI 1366413197)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992870976 NPI number — DR. KIM ROSAN TOUSIGNANT PSY.D.,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOUSIGNANT
Provider First Name:
KIM
Provider Middle Name:
ROSAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.,
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992870976
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1694
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUCKSPORT
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04416-1694
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-460-7974
Provider Business Mailing Address Fax Number:
207-469-1932

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
151 MAIN STREET
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
BUCKSPORT
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-460-7974
Provider Business Practice Location Address Fax Number:
207-469-1932
Provider Enumeration Date:
11/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PS1257 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 283850000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003401401 . This is a "MEDICARE PTAN" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 047415 . This is a "ANTHEM" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 7118205 . This is a "AETNA" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




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