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General NPI Number Information
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NPI Number | 1346330487
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Entity Type | Individual
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Provider Name | BARRY L EDITH LCSW
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Gender | Male
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 05/04/2021
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Provider Practice Location Address
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Address Line | 189 EXCHANGE ST 2201A &2201B
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City | BANGOR
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State | ME
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Zip | 04401-6507
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Country | US
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Telephone | 207-299-4947
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2342 2201A&2201B
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City | BANGOR
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State | ME
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Zip | 04402-2342
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Country | US
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Telephone | 207-299-4947
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC12264
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License Number State | ME
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