Provider Demographics
NPI:1689754889
Name:BARNETT, AMY (MS LADC CCS)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BARNETT
Suffix:
Gender:F
Credentials:MS LADC CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 MAIN ST STE 204
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04841-3388
Mailing Address - Country:US
Mailing Address - Phone:207-594-4828
Mailing Address - Fax:
Practice Address - Street 1:315 MAIN ST STE 204
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841-3388
Practice Address - Country:US
Practice Address - Phone:207-594-4828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC109101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME104000000Medicaid