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General NPI Number Information
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NPI Number | 1003117573
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Entity Type | Individual
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Provider Name | CYNTHIA SUE REID
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Gender | Female
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Dates
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Enumeration Date | 11/15/2010
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Last Update Date | 05/31/2012
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Provider Practice Location Address
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Address Line | 103 TEXAS AVE
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City | BANGOR
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State | ME
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Zip | 04401-4324
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Country | US
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Telephone | 207-553-5998
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Fax | 207-942-2722
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Provider Business Mailing Address
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Address Line | 103 TEXAS AVE
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City | BANGOR
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State | ME
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Zip | 04401-4324
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Country | US
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Telephone | 207-553-5998
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Fax | 207-942-2722
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | XL3593
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License Number State | ME
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CAC4852
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License Number State | ME
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