Provider Demographics
NPI:1861557423
Name:HALE, JOHN S JR (EDD LICENSED PSYCHOL)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:S
Last Name:HALE
Suffix:JR
Gender:M
Credentials:EDD LICENSED PSYCHOL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 HUDSON RD
Mailing Address - Street 2:
Mailing Address - City:GLENBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04401-1406
Mailing Address - Country:US
Mailing Address - Phone:207-944-0133
Mailing Address - Fax:
Practice Address - Street 1:607 HUDSON RD
Practice Address - Street 2:
Practice Address - City:GLENBURN
Practice Address - State:ME
Practice Address - Zip Code:04401-1406
Practice Address - Country:US
Practice Address - Phone:207-944-3804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2021-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS583103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME200700001Medicaid
ME200700001Medicaid