Provider Demographics
NPI:1053429308
Name:BANGOR FAMILY COUNSELING INC
Entity type:Organization
Organization Name:BANGOR FAMILY COUNSELING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:207-990-1555
Mailing Address - Street 1:96 HARLOW ST
Mailing Address - Street 2:STE 335
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401
Mailing Address - Country:US
Mailing Address - Phone:207-990-1555
Mailing Address - Fax:207-990-1555
Practice Address - Street 1:96 HARLOW ST
Practice Address - Street 2:STE 335
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401
Practice Address - Country:US
Practice Address - Phone:207-990-1555
Practice Address - Fax:207-990-1555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MM9253Medicare ID - Type Unspecified