Basic Information
Provider Information
NPI: 1619418860
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HUTCHINS
FirstName: MATTHEW
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: LCPC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 66 STONE ST
Address2:  
City: AUGUSTA
State: ME
PostalCode: 043305227
CountryCode: US
TelephoneNumber: 2078732136
FaxNumber:  
Practice Location
Address1: 66 STONE ST
Address2:  
City: AUGUSTA
State: ME
PostalCode: 043305227
CountryCode: US
TelephoneNumber: 2078732136
FaxNumber: 2076604529
Other Information
ProviderEnumerationDate: 03/20/2017
LastUpdateDate: 04/17/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/17/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500XCC5224MEY Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


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