Basic Information
| Provider Information | |||||||||
| NPI: | 1013194620 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MASSIE | ||||||||
| FirstName: | BETTY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 WAYMAN LN | ||||||||
| Address2: | |||||||||
| City: | BAR HARBOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 046091625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2072885081 | ||||||||
| FaxNumber: | 2072887024 | ||||||||
| Practice Location | |||||||||
| Address1: | 322 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BAR HARBOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 046091648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2072888604 | ||||||||
| FaxNumber: | 2072887024 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2008 | ||||||||
| LastUpdateDate: | 03/06/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TF0000X | Y | Behavioral Health & Social Service Providers | Psychologist | Family |
ID Information
| ID | Type | State | Issuer | Description | 432820999 | 05 | ME | MEDICAID | PS1214 | 01 | ME | MAINE LICENSE | OTHER |