Active NPI
Marc Mytar, PHD
- Psychologist
- Ellsworth, ME
National Provider Identifier
1568591709
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 0429
- Practice address
- 64 Church St
Ellsworth, ME 04605-1658 - Phone
- (207) 667-2095
- NPI assigned
- Mar 5, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 0429 | ME | Primary |
Addresses
Primary practice location
64 Church St
Ellsworth, ME 04605-1658
Mailing address
15 Mytar LN
Surry, ME 04684-3609
Phone (207) 667-2095
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0429 | Other | ME | ME PSYCHOLOGY LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0429 | ME | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173052800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1568591709",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15 MYTAR LN",
"city": "SURRY",
"state": "ME",
"postal_code": "046843609",
"telephone_number": "207-667-2095"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "64 CHURCH ST",
"city": "ELLSWORTH",
"state": "ME",
"postal_code": "046051658",
"telephone_number": "207-667-2095"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MYTAR",
"first_name": "MARC",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "ME",
"license": "0429",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ME PSYCHOLOGY LICENSE",
"identifier": "0429",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ellsworth, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.