Provider Demographics
NPI:1992870976
Name:TOUSIGNANT, KIM ROSAN (PSYD,)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:ROSAN
Last Name:TOUSIGNANT
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:PO BOX 1694
Mailing Address - Street 2:
Mailing Address - City:BUCKSPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04416-1694
Mailing Address - Country:US
Mailing Address - Phone:207-460-7974
Mailing Address - Fax:207-469-1932
Practice Address - Street 1:151 MAIN STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:BUCKSPORT
Practice Address - State:ME
Practice Address - Zip Code:04416
Practice Address - Country:US
Practice Address - Phone:207-460-7974
Practice Address - Fax:207-469-1932
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1257103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME283850000Medicaid
ME003401401OtherMEDICARE PTAN
ME047415OtherANTHEM
ME7118205OtherAETNA