Provider Demographics
NPI:1194207449
Name:BRAINERD, REBECCA REID (LCPC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:REID
Last Name:BRAINERD
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:ASHLEY
Other - Last Name:REID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16 VERRILL RD
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:ME
Mailing Address - Zip Code:04039-9596
Mailing Address - Country:US
Mailing Address - Phone:207-415-3631
Mailing Address - Fax:
Practice Address - Street 1:16 VERRILL RD
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:ME
Practice Address - Zip Code:04039-9596
Practice Address - Country:US
Practice Address - Phone:207-415-3631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEC4525101YM0800X
MECC4525101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health