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NPI Code Detail

MEDICARE: EVAN THOMAS BARDEN LADC

MEDICARE: EVAN THOMAS BARDEN LADC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorLC4527ME

General Provider Information

NPI Number : 1154698173
Entity Type Code : Individual
Provider Name (Legal Business Name) : EVAN THOMAS BARDEN LADC
Provider Business Mailing Address
First Line : 24 DUNN ST
Second Line :
City : AUBURN
State : ME
Zip : 04210-6821
Country : US
Telephone Number : 207-784-2901
Fax Number : 207-783-5134
Provider Business Practice Location Address
First Line : 24 DUNN ST
Second Line :
City : AUBURN
State : ME
Zip : 04210-6821
Country : US
Telephone Number : 207-784-2901
Fax Number : 207-783-5134
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/18/2011
Last Update Date : 11/18/2011

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Directions to “ EVAN THOMAS BARDEN LADC” Practice Location

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