MEDICARE: MICHAEL W. BEAN LCPC, LADC, 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	101Y00000X	Counselor	CC1560	ME
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	LC1428	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558695650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL W. BEAN LCPC, LADC, CC

Provider Business Mailing Address
First Line	:	58 PORTLAND RD #13
Second Line	:
City	:	KENNEBUNK
State	:	ME
Zip	:	04043-6650
Country	:	US
Telephone Number	:	207-985-8900
Fax Number	:

Provider Business Practice Location Address
First Line	:	58 PORTLAND ROAD #13
Second Line	:
City	:	KENNEBUNK
State	:	ME
Zip	:	04043-6650
Country	:	US
Telephone Number	:	207-985-8900
Fax Number	:

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

Provider Enumeration Date	:	09/23/2009
Last Update Date	:	08/27/2015

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