Provider Demographics
NPI:1881664506
Name:HODGSON, DONALD GENE (DMIN (PSYCH))
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:GENE
Last Name:HODGSON
Suffix:
Gender:M
Credentials:DMIN (PSYCH)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 WOODFORD ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-5602
Mailing Address - Country:US
Mailing Address - Phone:207-774-8243
Mailing Address - Fax:207-773-3317
Practice Address - Street 1:202 WOODFORD ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-5602
Practice Address - Country:US
Practice Address - Phone:207-774-8243
Practice Address - Fax:207-773-3317
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC857101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME022570OtherPIN FOR ANTHEM BC/BS