Individual
DR. MARC MYTAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
64 CHURCH ST, ELLSWORTH, ME 04605-1658
(207) 667-2095
Mailing address
15 MYTAR LN, SURRY, ME 04684-3609
(207) 667-2095
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
0429
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0429
ME PSYCHOLOGY LICENSE
ME
Enumeration date
03/05/2007
Last updated
07/08/2007
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