Provider Demographics
NPI:1659688299
Name:LIBBY, BRYCE JF (LCSW)
Entity Type:Individual
Prefix:MR
First Name:BRYCE
Middle Name:JF
Last Name:LIBBY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 FARWELL ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-4847
Mailing Address - Country:US
Mailing Address - Phone:207-376-5760
Mailing Address - Fax:
Practice Address - Street 1:183 MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7016
Practice Address - Country:US
Practice Address - Phone:207-376-5760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC113501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical