Provider Demographics
NPI:1053481549
Name:BOHAC-CARDELLO, PENNY (LCPC)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:BOHAC-CARDELLO
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1328
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04211-1328
Mailing Address - Country:US
Mailing Address - Phone:207-784-9185
Mailing Address - Fax:207-784-1594
Practice Address - Street 1:6 STATE ST STE 604
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5140
Practice Address - Country:US
Practice Address - Phone:207-942-8767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC572101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional