Provider Demographics
NPI:1558695650
Name:BEAN, MICHAEL W (LCPC, LADC, CC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:BEAN
Suffix:
Gender:M
Credentials:LCPC, LADC, CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 PORTLAND RD #13
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-6650
Mailing Address - Country:US
Mailing Address - Phone:207-985-8900
Mailing Address - Fax:
Practice Address - Street 1:58 PORTLAND ROAD #13
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-6650
Practice Address - Country:US
Practice Address - Phone:207-985-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC1560101Y00000X
MELC1428101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431726099Medicaid