Provider Demographics
NPI:1710211347
Name:MCNALLY, MARTE T (LCPC)
Entity type:Individual
Prefix:
First Name:MARTE
Middle Name:T
Last Name:MCNALLY
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 72
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073-0072
Mailing Address - Country:US
Mailing Address - Phone:207-490-6900
Mailing Address - Fax:207-324-0546
Practice Address - Street 1:32 PATRIOTS LN
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-2552
Practice Address - Country:US
Practice Address - Phone:207-490-6900
Practice Address - Fax:207-324-0546
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC2669101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional