Provider Demographics
NPI:1679605760
Name:WARREN, B. PASCHA (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:B.
Middle Name:PASCHA
Last Name:WARREN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 PATTEN DR
Mailing Address - Street 2:
Mailing Address - City:HERMON
Mailing Address - State:ME
Mailing Address - Zip Code:04401-0917
Mailing Address - Country:US
Mailing Address - Phone:207-990-1242
Mailing Address - Fax:207-990-1242
Practice Address - Street 1:6 STATE ST
Practice Address - Street 2:SUITE #507
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5112
Practice Address - Country:US
Practice Address - Phone:207-990-1242
Practice Address - Fax:207-990-1242
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC1044101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME036427OtherANTHEM PROVIDER #