Provider Demographics
NPI:1518069475
Name:FLEWELLING, ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:
Last Name:FLEWELLING
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 BAGADUCE LN
Mailing Address - Street 2:
Mailing Address - City:SEDGWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04676-3426
Mailing Address - Country:US
Mailing Address - Phone:207-359-8500
Mailing Address - Fax:207-359-8500
Practice Address - Street 1:189 BAGADUCE LN
Practice Address - Street 2:
Practice Address - City:SEDGWICK
Practice Address - State:ME
Practice Address - Zip Code:04676-3426
Practice Address - Country:US
Practice Address - Phone:207-359-8500
Practice Address - Fax:207-359-8500
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS974103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME196350000Medicaid
MM8138Medicare PIN
R12572Medicare UPIN