Diane Alicia Tennies, PH.D.

Primary specialty

Forensic PsychologistTaxonomy code 103TF0200X

License

PS955 Issued in ME

Practice address

115 Franklin St
Suite 1a
Bangor, ME 04401-4936

Phone

(207) 942-3635

Fax

(207) 941-1933

NPI assigned

Jan 10, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1366070400000",
    "number": "1023168531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 FRANKLIN ST",
            "address_2": "SUITE 1A",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044014936",
            "telephone_number": "207-942-3635",
            "fax_number": "207-941-1933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 FRANKLIN ST",
            "address_2": "SUITE 1A",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044014936",
            "telephone_number": "207-942-3635",
            "fax_number": "207-941-1933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TENNIES",
        "first_name": "DIANE",
        "middle_name": "ALICIA",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-10",
        "last_updated": "2013-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TA0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "ME",
            "license": "LC 1572",
            "primary": false
        },
        {
            "code": "103TF0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Forensic",
            "state": "ME",
            "license": "PS955",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "043983",
            "state": "ME"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "231220000",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary Tedesco-Schneck, PNPC
• Ledor Friday Teekate
• Jacqueline Teele, CCP
• Nina Tekelenburg
• Lucus Temple, LMSW-CC
• Manika Thakur, MD
• Jessica Thayer, DMD
• The Aware Center for Early Intervention, LLC
• The Bangor Area Homeless Shelter
• The Bodyworks

• Forensic Psychologist in Bangor, ME
• Providers in Bangor, ME by specialty
• Forensic Psychologist in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.