Healthcare Provider Details

I. General information

NPI: 1164575593
Provider Name (Legal Business Name): BRONWYN HARPER LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BRONWYN UMPHREY LCPC

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 NORFOLK ST
BANGOR ME
04401-3467
US

IV. Provider business mailing address

PO BOX 67
BANGOR ME
04402-0067
US

V. Phone/Fax

Practice location:
  • Phone: 207-479-8594
  • Fax:
Mailing address:
  • Phone: 207-479-8594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC3063
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: