Provider Demographics
NPI:1861596082
Name:LETSCH, BRUCE ALLAN (PHD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ALLAN
Last Name:LETSCH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:396 STEVENSTOWN RD.
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04350-4207
Mailing Address - Country:US
Mailing Address - Phone:207-582-7095
Mailing Address - Fax:
Practice Address - Street 1:396 STEVENSTOWN RD.
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:ME
Practice Address - Zip Code:04350-4207
Practice Address - Country:US
Practice Address - Phone:207-582-7095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME495103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical