Provider Demographics
NPI:1891858965
Name:KUNIN, HOWARD MARK (PSYD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:MARK
Last Name:KUNIN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 BRIGHTON AVENUE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102
Mailing Address - Country:US
Mailing Address - Phone:207-662-8660
Mailing Address - Fax:207-662-8492
Practice Address - Street 1:335 BRIGHTON AVENUE
Practice Address - Street 2:SUITE 201
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102
Practice Address - Country:US
Practice Address - Phone:207-662-8660
Practice Address - Fax:207-662-8492
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1004103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical