MEDICARE: KARA BRYANT LMSW-CC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	MC11113	ME

General Provider Information

NPI Number	:	1508066556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARA BRYANT LMSW-CC

Provider Business Mailing Address
First Line	:	38 PURKIS RD
Second Line	:
City	:	BUCKFIELD
State	:	ME
Zip	:	04220-4003
Country	:	US
Telephone Number	:	207-570-7193
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 SUMMER ST
Second Line	:
City	:	BANGOR
State	:	ME
Zip	:	04401-6446
Country	:	US
Telephone Number	:	207-945-4240
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2007
Last Update Date	:	01/04/2010

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