Provider Demographics
NPI:1629181078
Name:HANLEY, CONSTANCE (PHD)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:
Last Name:HANLEY
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 1:192 YORK ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909
Mailing Address - Country:US
Mailing Address - Phone:207-363-2164
Mailing Address - Fax:207-363-7808
Practice Address - Street 1:192 YORK ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909
Practice Address - Country:US
Practice Address - Phone:207-363-2164
Practice Address - Fax:207-363-7808
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME00466103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME003281OtherSTAR
ME126560000Medicaid
4221194OtherAETNA
ME017671OtherANTHEM BC BS
ME527600001OtherMAGELLAN
4221194OtherAETNA