Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PS631 | ME |
Y | 103T00000X | Psychologist | PS631 | ME |
NPI | 1003928540 |
---|---|
Provider Name | Jeffrey Whitehead Aston |
First Address | Bangor, ME 04401-5956 |
Second Address | Bangor, ME 04401-5609 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q52559 | (02) |