Provider Demographics
NPI:1598482382
Name:HANNIGAN ANCTIL, DEBRA A (MS)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:A
Last Name:HANNIGAN ANCTIL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 CROSS RD
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ME
Mailing Address - Zip Code:04258-4406
Mailing Address - Country:US
Mailing Address - Phone:207-650-1934
Mailing Address - Fax:
Practice Address - Street 1:36 OAK ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7190
Practice Address - Country:US
Practice Address - Phone:207-795-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPE886103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool