Provider Demographics
NPI:1699313098
Name:SCAMMAN, MARY E (PSYD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:SCAMMAN
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 1:414 SAWYER ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-3961
Mailing Address - Country:US
Mailing Address - Phone:207-415-7469
Mailing Address - Fax:
Practice Address - Street 1:414 SAWYER ST
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-3961
Practice Address - Country:US
Practice Address - Phone:207-415-7469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1347103TS0200X
103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool