Provider Demographics
NPI:1578613816
Name:BLUE HILL PSYCHOLOGICAL SERVICES INC
Entity Type:Organization
Organization Name:BLUE HILL PSYCHOLOGICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:H
Authorized Official - Last Name:HUCKEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:207-374-5811
Mailing Address - Street 1:PO BOX 161
Mailing Address - Street 2:
Mailing Address - City:BLUE HILL
Mailing Address - State:ME
Mailing Address - Zip Code:04614-0161
Mailing Address - Country:US
Mailing Address - Phone:207-374-5811
Mailing Address - Fax:866-620-9643
Practice Address - Street 1:65 UNION ST.
Practice Address - Street 2:
Practice Address - City:BLUE HILL
Practice Address - State:ME
Practice Address - Zip Code:04416
Practice Address - Country:US
Practice Address - Phone:207-374-5811
Practice Address - Fax:866-620-9643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS758103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME12706000Medicaid
MEMM5668Medicare ID - Type Unspecified