Provider Demographics
NPI:1588655484
Name:HANDY, BONNIE (LCSW, LADC)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:
Last Name:HANDY
Suffix:
Gender:F
Credentials:LCSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:ME
Mailing Address - Zip Code:04039-0160
Mailing Address - Country:US
Mailing Address - Phone:207-653-1371
Mailing Address - Fax:
Practice Address - Street 1:57 TANDBERG TRL
Practice Address - Street 2:SUITE #6
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-6425
Practice Address - Country:US
Practice Address - Phone:207-653-1371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC66461041C0700X
MELC3393101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEME1202Medicare ID - Type Unspecified