Provider Demographics
NPI:1053678714
Name:MASTEN, BRANDI (CADC)
Entity Type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:
Last Name:MASTEN
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-4602
Mailing Address - Country:US
Mailing Address - Phone:207-210-0148
Mailing Address - Fax:
Practice Address - Street 1:105 MIDDLE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7037
Practice Address - Country:US
Practice Address - Phone:207-795-0149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMH605962101YA0400X
MESA606205101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)