Provider Demographics
NPI:1588736334
Name:STANCHFIELD, LORA L (PH D)
Entity type:Individual
Prefix:
First Name:LORA
Middle Name:L
Last Name:STANCHFIELD
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 ELM ST
Mailing Address - Street 2:
Mailing Address - City:HOULTON
Mailing Address - State:ME
Mailing Address - Zip Code:04730-2215
Mailing Address - Country:US
Mailing Address - Phone:207-745-3375
Mailing Address - Fax:
Practice Address - Street 1:14 ELM ST
Practice Address - Street 2:
Practice Address - City:HOULTON
Practice Address - State:ME
Practice Address - Zip Code:04730-2215
Practice Address - Country:US
Practice Address - Phone:540-440-1609
Practice Address - Fax:207-815-5734
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEME PS1014103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
100284OtherANTHEM
100284OtherANTHEM
ME202530099Medicare ID - Type Unspecified