Provider Demographics
NPI:1487726980
Name:DEVINE, DONALD (PHD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:DEVINE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 POINT RD
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:ME
Mailing Address - Zip Code:04917-4521
Mailing Address - Country:US
Mailing Address - Phone:207-495-2000
Mailing Address - Fax:207-286-3218
Practice Address - Street 1:278 POINT RD
Practice Address - Street 2:
Practice Address - City:BELGRADE
Practice Address - State:ME
Practice Address - Zip Code:04917-4521
Practice Address - Country:US
Practice Address - Phone:207-495-2000
Practice Address - Fax:207-286-3218
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS337103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME038359OtherANTHEM
ME129630099Medicaid
MES32231Medicare UPIN
ME129630099Medicaid