Provider Demographics
NPI:1821394636
Name:MARBLESTONE, JUDY K (LMFT)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:K
Last Name:MARBLESTONE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 PARK ROW
Mailing Address - Street 2:SUITE 303
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2053
Mailing Address - Country:US
Mailing Address - Phone:207-837-6574
Mailing Address - Fax:207-837-6597
Practice Address - Street 1:153 PARK ROW
Practice Address - Street 2:SUITE 303
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2053
Practice Address - Country:US
Practice Address - Phone:207-837-6574
Practice Address - Fax:207-837-6597
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-27
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMF4101106H00000X
MELC5032101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)