Provider Demographics
NPI:1497121107
Name:LIBBY, JULIE (LCPCC)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:
Last Name:LIBBY
Suffix:
Gender:F
Credentials:LCPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 WATER ST
Mailing Address - Street 2:
Mailing Address - City:HALLOWELL
Mailing Address - State:ME
Mailing Address - Zip Code:04347-1437
Mailing Address - Country:US
Mailing Address - Phone:207-779-7582
Mailing Address - Fax:
Practice Address - Street 1:52 WATER ST
Practice Address - Street 2:
Practice Address - City:HALLOWELL
Practice Address - State:ME
Practice Address - Zip Code:04347-1437
Practice Address - Country:US
Practice Address - Phone:207-779-7582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL4561101YM0800X
MEXP4269101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME02988OtherLOCUS RATER ID