Provider Demographics
NPI:1033261102
Name:WHEELER, ELIZABETH V (PHD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:V
Last Name:WHEELER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MIDDLE STREET
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101
Mailing Address - Country:US
Mailing Address - Phone:207-712-1853
Mailing Address - Fax:207-773-5512
Practice Address - Street 1:25 MIDDLE STREET
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101
Practice Address - Country:US
Practice Address - Phone:207-712-1853
Practice Address - Fax:207-773-5512
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1130103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME017608OtherVALUE OPTIONS
ME431546200Medicaid
ME048089OtherANTHEM
ME431546200Medicaid