Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PS929 | ME |
N | 103T00000X | Psychologist | PS929 | ME |
N | 103TA0700X | Adult Development & Aging Psychologist | PS929 | ME |
N | 103G00000X | Clinical Psychologist | PS929 | ME |
N | 103TC0700X | Clinical Psychologist | PS929 | ME |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PS929 | ME |
N | 103TF0200X | Forensic Psychologist | PS929 | ME |
N | 103TS0200X | School Psychologist | PS929 | ME |
NPI | 1669529376 |
---|---|
Provider Name | Dr. Carol Lynn C Kabacoff |
First Address | South Portland, ME 04106-2820 |
Second Address | South Portland, ME 04106-2820 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2007 |
Last Update Date | 08/07/2007 |