Provider Demographics
NPI:1962553065
Name:GARY RASMUSSEN, PH.D. CLINICAL PSYCHOLOGIST PA
Entity type:Organization
Organization Name:GARY RASMUSSEN, PH.D. CLINICAL PSYCHOLOGIST PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:G
Authorized Official - Last Name:RASMUSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:207-872-5003
Mailing Address - Street 1:3 THOMAS DR
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4407
Mailing Address - Country:US
Mailing Address - Phone:207-872-5003
Mailing Address - Fax:207-872-9445
Practice Address - Street 1:179 MAIN ST STE 208
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-6672
Practice Address - Country:US
Practice Address - Phone:207-872-5003
Practice Address - Fax:207-872-9445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME491103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME703808Medicare ID - Type Unspecified