Provider Demographics
NPI:1902374507
Name:MCIVER, MATTHEW
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:MCIVER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 CAPTAIN CUSHMAN RD
Mailing Address - Street 2:
Mailing Address - City:MORRILL
Mailing Address - State:ME
Mailing Address - Zip Code:04952-5035
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:67 CAPTAIN CUSHMAN RD
Practice Address - Street 2:
Practice Address - City:MORRILL
Practice Address - State:ME
Practice Address - Zip Code:04952-5035
Practice Address - Country:US
Practice Address - Phone:207-342-3655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC176041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMC17604OtherMASTER SOCIAL WORKER- CONDITIONAL CLINICAL