Basic Information
| Provider Information | |||||||||
| NPI: | 1649475682 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMALL | ||||||||
| FirstName: | CATHLEEN | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D., BCBA-D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1577 CONGRESS ST | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041022169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076625522 | ||||||||
| FaxNumber: | 2077741814 | ||||||||
| Practice Location | |||||||||
| Address1: | 301C US ROUTE 1 | ||||||||
| Address2: | |||||||||
| City: | SCARBOROUGH | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040749701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2073968600 | ||||||||
| FaxNumber: | 2073968632 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2007 | ||||||||
| LastUpdateDate: | 07/12/2013 | ||||||||
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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 | 103T00000X | 04783 | MD | N | Behavioral Health & Social Service Providers | Psychologist | 103K00000X | 1-05-2441 | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 103T00000X | PS1380 | ME | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.