Provider Demographics
NPI:1710767892
Name:MOON, BRIANNA MAE (CADC)
Entity Type:Individual
Prefix:MISS
First Name:BRIANNA
Middle Name:MAE
Last Name:MOON
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 DARLING ESTS
Mailing Address - Street 2:
Mailing Address - City:WEST ENFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04493-4468
Mailing Address - Country:US
Mailing Address - Phone:207-290-7677
Mailing Address - Fax:
Practice Address - Street 1:689 ODLIN RD
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6709
Practice Address - Country:US
Practice Address - Phone:207-518-7818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC8377101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)