Provider Demographics
NPI:1528398104
Name:WIKTOR, BEATA ANNA (PSYD)
Entity type:Individual
Prefix:DR
First Name:BEATA
Middle Name:ANNA
Last Name:WIKTOR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 2074
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04211
Mailing Address - Country:US
Mailing Address - Phone:207-657-8311
Mailing Address - Fax:207-221-1496
Practice Address - Street 1:6 MAINE STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:GRAY
Practice Address - State:ME
Practice Address - Zip Code:04039
Practice Address - Country:US
Practice Address - Phone:207-657-8311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-05
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1417103T00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist