| Lydia Ward-gray, Psyd, Llc | |
|
19 South Street Suite 4 Portland ME 04101 | |
| (207) 232-4508 | |
| Not Available |
| Full Name | Lydia Ward-gray, Psyd, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 19 South Street, Portland, Maine |
| Authorized Official Name and Position | Lydia Ward-gray (CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 2072324508 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lydia Ward-gray, Psyd, Llc 19 South St Suite 4 Portland ME 04101-3963 Ph: (207) 232-4508 | Lydia Ward-gray, Psyd, Llc 19 South Street Suite 4 Portland ME 04101 Ph: (207) 232-4508 |
| NPI Number | 1578019113 |
|---|---|
| Provider Enumeration Date | 09/01/2016 |
| Last Update Date | 09/01/2016 |
| Medicare PECOS PAC ID | 8022393479 |
|---|---|
| Medicare Enrollment ID | O20201216001860 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578019113 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PS881 (Maine) | Primary |
| Provider Name | Lydia S Ward-gray |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1992812770 PECOS PAC ID: 9537341656 Enrollment ID: I20110310000991 |
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