MEDICARE: EDWIN I VAN BIBBER-ORR LCPC-C

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	101YP2500X	Professional Counselor	XL6833	ME

General Provider Information

NPI Number	:	1922717313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWIN I VAN BIBBER-ORR LCPC-C

Provider Business Mailing Address
First Line	:	89 ANDERSON ST UNIT 406
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04101-6804
Country	:	US
Telephone Number	:	802-349-3909
Fax Number	:

Provider Business Practice Location Address
First Line	:	967 BROADWAY STE 2
Second Line	:
City	:	SOUTH PORTLAND
State	:	ME
Zip	:	04106-4263
Country	:	US
Telephone Number	:	802-349-3909
Fax Number	:

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

Provider Enumeration Date	:	11/15/2022
Last Update Date	:	11/15/2022

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