MEDICARE: MS. PHYLLIS DARLINGTON HAVENS RD, LCSW

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	LC6946	ME
2	133V00000X	Registered Dietitian	D198	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	002160	OTHER	ME	ANTHEM BCBS

General Provider Information

NPI Number	:	1528275385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PHYLLIS DARLINGTON HAVENS RD, LCSW

Provider Business Mailing Address
First Line	:	60 KENNEBEC RD
Second Line	:
City	:	HAMPDEN
State	:	ME
Zip	:	04444-1341
Country	:	US
Telephone Number	:	207-862-2349
Fax Number	:	207-990-3896

Provider Business Practice Location Address
First Line	:	40 SUMMER ST
Second Line	:
City	:	BANGOR
State	:	ME
Zip	:	04401-6446
Country	:	US
Telephone Number	:	207-990-3896
Fax Number	:	207-990-3896

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

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	09/11/2025

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