Provider Demographics
NPI:1275927808
Name:MAGILL, SUSAN J (MA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:MAGILL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:J
Other - Last Name:MERACLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:91 UNION ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-2161
Mailing Address - Country:US
Mailing Address - Phone:603-948-9458
Mailing Address - Fax:
Practice Address - Street 1:91 UNION ST APT 1
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-2161
Practice Address - Country:US
Practice Address - Phone:603-948-9458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-20
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor