Provider Demographics
NPI:1063563161
Name:DROUIN, KIMBERLY CHRISTINE (PHD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:CHRISTINE
Last Name:DROUIN
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 1:609 MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-5453
Mailing Address - Country:US
Mailing Address - Phone:207-775-2220
Mailing Address - Fax:207-775-2226
Practice Address - Street 1:609 MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-5453
Practice Address - Country:US
Practice Address - Phone:207-775-2220
Practice Address - Fax:207-775-2226
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8121103T00000X
MEPS1191103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME0006065OtherMEDICARE PTAN
MA472796000OtherMAGELLAN
MAW06272OtherBCBS OF MASS.
ME0006065OtherMEDICARE PTAN