Provider Demographics
NPI:1700843703
Name:PARTRIDGE-BARBER, AMY (LCSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:PARTRIDGE-BARBER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 CITY CTR
Mailing Address - Street 2:FL 1
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-6427
Mailing Address - Country:US
Mailing Address - Phone:207-266-4102
Mailing Address - Fax:
Practice Address - Street 1:4 CITY CTR
Practice Address - Street 2:FL 1
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-6427
Practice Address - Country:US
Practice Address - Phone:207-266-4102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC60761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME312680099Medicaid
ME079209OtherBLUECROSSBLUESHIELD
ME079209OtherBLUECROSSBLUESHIELD