Healthcare Provider Details

I. General information

NPI: 1912858101
Provider Name (Legal Business Name): EMMA BAGBY LMSW-CC, CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2026
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 FOREST AVE STE 200
PORTLAND ME
04103-1889
US

IV. Provider business mailing address

1250 FOREST AVE STE 200
PORTLAND ME
04103-1889
US

V. Phone/Fax

Practice location:
  • Phone: 207-203-7933
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCAC9141
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberMC25688
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: