LARISSA ARAXE MEAD-WESCOTT PHD

Clinical Neuropsychologist

Bangor, Maine

Provider NPI: 1417922725

Provider Information:
 LARISSA ARAXE MEAD-WESCOTT PHD
Gender: F
Not Sole Proprietor

Practice Location:
277 STATE ST SUITE 2A BANGOR, ME 04401 US
Tel: 207-990-2580  Fax: 207-990-1930

Business Mailing Address:
277 STATE ST SUITE 2A BANGOR, ME 04401 US
Tel: 207-990-2580  Fax: 207-990-1930

Entity Type: Individual

Taxonomy:

Primary	Code	Category/Description	State	License Number
Y	103G00000X	Behavioral Health & Social Service Providers Clinical Neuropsychologist	ME	PS960

Other Provider Identifiers:

Issuer	Number	State	Type
AETNA	3069401		01
ANTHEM	036895		01
	330640099	ME	05

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin

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