Healthcare Provider Details

I. General information

NPI: 1235054594
Provider Name (Legal Business Name): OLIVIA BRADSTREET
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 COLLEGE AVE STE 304
WATERVILLE ME
04901-6100
US

IV. Provider business mailing address

700 MOUNT HOPE AVE STE 320
BANGOR ME
04401-5664
US

V. Phone/Fax

Practice location:
  • Phone: 207-992-0650
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberMC26356
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: