Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PS714 | ME |
Y | 103T00000X | Psychologist | PS714 | ME |
NPI | 1003037391 |
---|---|
Provider Name | Lois A Grocki |
First Address | Westbrook, ME 04092-3848 |
Second Address | Westbrook, ME 04092-3848 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 08/07/2007 |