Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PS1020 | ME |
Y | 103TC0700X | Clinical Psychologist | PS1020 | ME |
NPI | 1003977018 |
---|---|
Provider Name | Dr. Toby A Ansfield |
First Address | Yarmouth, ME 04096-6759 |
Second Address | Portland, ME 04101-4261 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 20/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1346400000 | (05) | ME |