Provider Demographics
NPI:1164575593
Name:UMPHREY, BRONWYN ELIZABETH (LCPC)
Entity Type:Individual
Prefix:MS
First Name:BRONWYN
Middle Name:ELIZABETH
Last Name:UMPHREY
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 921
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-0921
Mailing Address - Country:US
Mailing Address - Phone:207-667-8594
Mailing Address - Fax:
Practice Address - Street 1:5 SCHOOL ST
Practice Address - Street 2:SUITE # 10
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1932
Practice Address - Country:US
Practice Address - Phone:207-667-8594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC3063101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME100331OtherANTHEM
ME7401824OtherAETNA