Provider Demographics
NPI:1831260926
Name:HANEY, ELLEN (LCPC)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:HANEY
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 1:57 HILLIS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-2418
Mailing Address - Country:US
Mailing Address - Phone:207-871-1200
Mailing Address - Fax:207-871-1232
Practice Address - Street 1:17 BISHOP ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-2659
Practice Address - Country:US
Practice Address - Phone:207-871-1235
Practice Address - Fax:207-879-6161
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC1537101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME298120099Medicaid
MECAC2975OtherALCOHOL AND ABUSE COUNS.
MERB9OtherANTHEM