Provider Demographics
NPI:1205215290
Name:MEISTER, BRIANNA J
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:J
Last Name:MEISTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 NO HIGH STREET
Mailing Address - Street 2:
Mailing Address - City:BRIDGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04009
Mailing Address - Country:US
Mailing Address - Phone:207-647-5629
Mailing Address - Fax:207-647-5620
Practice Address - Street 1:37 NO HIGH STREET
Practice Address - Street 2:
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009
Practice Address - Country:US
Practice Address - Phone:207-647-5629
Practice Address - Fax:207-647-5620
Is Sole Proprietor?:No
Enumeration Date:2015-05-22
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL 4094101YM0800X
MECC4463101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health