Provider Demographics
NPI:1225149826
Name:KERRIGAN, BARBARA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:
Last Name:KERRIGAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 STATE ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5417
Mailing Address - Country:US
Mailing Address - Phone:207-990-0188
Mailing Address - Fax:207-990-6604
Practice Address - Street 1:268 STATE ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5417
Practice Address - Country:US
Practice Address - Phone:207-990-0188
Practice Address - Fax:207-990-6604
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2009-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC59371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME154540199OtherHEALTH PLANS INC. ID#
ME14Z030228ME01OtherANTHEM BILLING ID#
ME154540199Medicaid