Provider Demographics
NPI:1942545371
Name:HALL, MATTHEW W (LCPC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:W
Last Name:HALL
Suffix:
Gender:M
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 8
Mailing Address - Street 2:
Mailing Address - City:EAST MACHIAS
Mailing Address - State:ME
Mailing Address - Zip Code:04630-0008
Mailing Address - Country:US
Mailing Address - Phone:207-726-8474
Mailing Address - Fax:888-518-2282
Practice Address - Street 1:567 MAIN STREET
Practice Address - Street 2:
Practice Address - City:EAST MACHIAS
Practice Address - State:ME
Practice Address - Zip Code:04630
Practice Address - Country:US
Practice Address - Phone:207-726-8474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-12
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC4421101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME01-0276859Medicaid