Provider Demographics
NPI:1992250328
Name:MARTIN, DEAN (LCPC LADC)
Entity type:Individual
Prefix:MR
First Name:DEAN
Middle Name:
Last Name:MARTIN
Suffix:
Gender:M
Credentials:LCPC LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MARTIN DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:ME
Mailing Address - Zip Code:04344-4656
Mailing Address - Country:US
Mailing Address - Phone:207-530-1376
Mailing Address - Fax:
Practice Address - Street 1:2 BEECH ST
Practice Address - Street 2:
Practice Address - City:HALLOWELL
Practice Address - State:ME
Practice Address - Zip Code:04347-1518
Practice Address - Country:US
Practice Address - Phone:207-530-1376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-15
Last Update Date:2017-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC4578101YA0400X
MECC4614101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MECC4614Medicaid