Provider Demographics
NPI:1043255136
Name:BREWSTER, ARLENE BLANK (PHD)
Entity type:Individual
Prefix:
First Name:ARLENE
Middle Name:BLANK
Last Name:BREWSTER
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 1:7 BOND RD
Mailing Address - Street 2:
Mailing Address - City:KITTERY POINT
Mailing Address - State:ME
Mailing Address - Zip Code:03905-5614
Mailing Address - Country:US
Mailing Address - Phone:207-439-6025
Mailing Address - Fax:
Practice Address - Street 1:7 BOND RD
Practice Address - Street 2:
Practice Address - City:KITTERY POINT
Practice Address - State:ME
Practice Address - Zip Code:03905-5614
Practice Address - Country:US
Practice Address - Phone:207-439-4001
Practice Address - Fax:207-439-2254
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1283103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME0015091Medicare PIN