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General NPI Number Information
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NPI Number | 1053481549
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Entity Type | Individual
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Provider Name | PENNY BOHAC-CARDELLO LCPC
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Gender | Female
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 6 STATE ST STE 604
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City | BANGOR
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State | ME
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Zip | 04401-5140
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Country | US
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Telephone | 207-942-8767
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1328
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City | AUBURN
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State | ME
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Zip | 04211-1328
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Country | US
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Telephone | 207-784-9185
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Fax | 207-784-1594
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | CC572
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License Number State | ME
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