Glen E Davis, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PS593 Issued in ME

Practice address

14 Stonewall Way
Falmouth, ME 04105-2491

Phone

(207) 221-2631

Fax

(866) 611-6717

NPI assigned

Jun 12, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Maine Child Psychology

  • Clinical Child & Adolescent Psychologist
  • Falmouth, ME
  • NPI 1760744601
  NPD Authorized official

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645056000000",
    "number": "1194767137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 STONEWALL WAY",
            "city": "FALMOUTH",
            "state": "ME",
            "postal_code": "041052491",
            "telephone_number": "207-221-2631",
            "fax_number": "866-611-6717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 STONEWALL WAY",
            "city": "FALMOUTH",
            "state": "ME",
            "postal_code": "041052491",
            "telephone_number": "207-221-2631",
            "fax_number": "866-611-6717"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14 Stonewall Way",
            "address_purpose": "LOCATION",
            "city": "Falmouth",
            "state": "ME",
            "postal_code": "041052491",
            "country_code": "US",
            "telephone_number": "207-221-2631",
            "fax_number": "866-611-6717",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "GLEN",
        "middle_name": "E",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2022-02-17",
        "certification_date": "2022-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "ME",
            "license": "PS593",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "ME",
            "license": "PS593",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "154420000",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amanda Jean Daigle, LCSW
• David E Daigle, D.C.
• Clare Dalton
• Cynthia M Darling
• Davis Long Term Care Group Inc
• Harleigh T Dawson, LCPC
• Reinaldo De Los Heros, M.D.
• Charles Joseph De Sieyes, M.D.
• Heather Dean
• Christopher Decker, DO

• Psychologist in Falmouth, ME
• Providers in Falmouth, ME by specialty
• Psychologist in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2022; 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.