Provider Demographics
NPI:1942453246
Name:HUNTER, MARCIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:
Last Name:HUNTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 COMMERCIAL ST
Mailing Address - Street 2:STE 303
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-4613
Mailing Address - Country:US
Mailing Address - Phone:207-871-0171
Mailing Address - Fax:
Practice Address - Street 1:225 COMMERCIAL ST
Practice Address - Street 2:STE 303
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-4613
Practice Address - Country:US
Practice Address - Phone:207-871-0171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS966103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME208100100Medicaid