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General NPI Number Information
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NPI Number | 1265205702
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Entity Type | Individual
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Provider Name | MRS. MISTY LYNNE WARD
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Gender | Female
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Dates
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Enumeration Date | 11/06/2023
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Last Update Date | 11/10/2023
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Provider Practice Location Address
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Address Line | 877 STILLWATER AVE
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City | BANGOR
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State | ME
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Zip | 04401-3601
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Country | US
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Telephone | 207-245-7654
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Fax |
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Provider Business Mailing Address
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Address Line | 182 BACK SEARSPORT RD
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City | BELFAST
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State | ME
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Zip | 04915-7043
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Country | US
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Telephone | 207-505-6903
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Fax |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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