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General NPI Number Information
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NPI Number | 1578354502
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Entity Type | Organization
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Legal Business Name | MAINE STREET MEDICINE WORKS, PLLC
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Dates
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Enumeration Date | 05/17/2025
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Last Update Date | 05/17/2025
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Provider Practice Location Address
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Address Line | 157 PARK ST STE 32
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City | BANGOR
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State | ME
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Zip | 04401-5093
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Country | US
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Telephone | 802-451-9681
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Fax | 207-406-5354
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Provider Business Mailing Address
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Address Line | PO BOX 277
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City | ORONO
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State | ME
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Zip | 04473-0277
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Country | US
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Telephone | 802-451-9681
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Fax | 207-406-5354
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | MS. BARBARA JANE MAINGUY
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Credential | LCSW
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Telephone | 802-451-9681
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 202D00000X
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Taxonomy Name | Integrative Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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