Provider Demographics
NPI:1578785812
Name:MENARD, MARY MARGARET (LADC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MARGARET
Last Name:MENARD
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:MARGARET
Other - Last Name:KUPEC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CADAC
Mailing Address - Street 1:PO BOX 6305
Mailing Address - Street 2:605 ROUTE ONE SUITE 4
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04070-6305
Mailing Address - Country:US
Mailing Address - Phone:207-885-1060
Mailing Address - Fax:207-885-1061
Practice Address - Street 1:605 ROUTE ONE
Practice Address - Street 2:SUITE 4
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04070-6305
Practice Address - Country:US
Practice Address - Phone:207-885-1060
Practice Address - Fax:207-885-1061
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC1585101YA0400X
MA0766AD101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)