Provider Demographics
NPI:1609984749
Name:THURSTON, MARGO BONNER (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARGO
Middle Name:BONNER
Last Name:THURSTON
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 1:321 MUZZY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SEARSMONT
Mailing Address - State:ME
Mailing Address - Zip Code:04973-3201
Mailing Address - Country:US
Mailing Address - Phone:207-342-5126
Mailing Address - Fax:
Practice Address - Street 1:143 HIGH ST
Practice Address - Street 2:SUITE 22
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-6548
Practice Address - Country:US
Practice Address - Phone:207-338-0849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS818103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM6963Medicare ID - Type Unspecified