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General NPI Number Information
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NPI Number | 1508259532
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Entity Type | Individual
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Provider Name | ELIZABETH BACON LCSW, CADC
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Gender | Female
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Dates
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Enumeration Date | 03/16/2015
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Last Update Date | 10/11/2021
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Provider Practice Location Address
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Address Line | 1 HARNOIS AVE
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City | WESTBROOK
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State | ME
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Zip | 04092-4392
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Country | US
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Telephone | 207-662-1340
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Fax | 207-662-1341
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Provider Business Mailing Address
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Address Line | 899 RIVERSIDE ST
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City | PORTLAND
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State | ME
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Zip | 04103-1070
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Country | US
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Telephone |
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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 | LC16586
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | MC15240
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License Number State | ME
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