Provider Demographics
NPI:1720098478
Name:MCMANUS-RICHTER, MARY LOU (LCPC)
Entity Type:Individual
Prefix:
First Name:MARY LOU
Middle Name:
Last Name:MCMANUS-RICHTER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 440
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:ME
Mailing Address - Zip Code:04039-0440
Mailing Address - Country:US
Mailing Address - Phone:207-712-6131
Mailing Address - Fax:207-221-1357
Practice Address - Street 1:67 SHAKER RD
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:ME
Practice Address - Zip Code:04039-9640
Practice Address - Country:US
Practice Address - Phone:207-712-6131
Practice Address - Fax:207-221-1357
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC1134101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional