Provider Demographics
NPI:1548444714
Name:HUCKEL, LORRAINE H (PHD)
Entity type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:H
Last Name:HUCKEL
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:PO BOX 161
Mailing Address - Street 2:
Mailing Address - City:BLUE HILL
Mailing Address - State:ME
Mailing Address - Zip Code:04614-0161
Mailing Address - Country:US
Mailing Address - Phone:207-374-5811
Mailing Address - Fax:866-620-9643
Practice Address - Street 1:65 UNION STREET
Practice Address - Street 2:
Practice Address - City:BLUE HILL
Practice Address - State:ME
Practice Address - Zip Code:04614-0161
Practice Address - Country:US
Practice Address - Phone:207-374-5811
Practice Address - Fax:866-620-9643
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS758103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME127060000Medicaid
MEMM5668Medicare PIN