Provider Demographics
NPI:1588964720
Name:MARSTERS, REGINA P (LCPC, PHD)
Entity type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:P
Last Name:MARSTERS
Suffix:
Gender:F
Credentials:LCPC, PHD
Other - Prefix:DR
Other - First Name:REGINA
Other - Middle Name:
Other - Last Name:MARSTERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC, PHD
Mailing Address - Street 1:58 BRACKETT RD
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04038-1803
Mailing Address - Country:US
Mailing Address - Phone:207-400-6767
Mailing Address - Fax:
Practice Address - Street 1:53 COUNTY RD
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038
Practice Address - Country:US
Practice Address - Phone:207-400-6767
Practice Address - Fax:207-510-0604
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC4386101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health