Provider Demographics
NPI:1811401227
Name:ONKTUSH, MARYBETH (CADC)
Entity Type:Individual
Prefix:
First Name:MARYBETH
Middle Name:
Last Name:ONKTUSH
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:ALFRED
Mailing Address - State:ME
Mailing Address - Zip Code:04002-3296
Mailing Address - Country:US
Mailing Address - Phone:207-324-1137
Mailing Address - Fax:207-324-5290
Practice Address - Street 1:105 GARLAND RD
Practice Address - Street 2:
Practice Address - City:WEST NEWFIELD
Practice Address - State:ME
Practice Address - Zip Code:04095-3527
Practice Address - Country:US
Practice Address - Phone:207-324-1137
Practice Address - Fax:207-324-5290
Is Sole Proprietor?:No
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC5561101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)