Provider Demographics
NPI:1821330721
Name:BARDWELL, ELIZABETH E (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:E
Last Name:BARDWELL
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:PO BOX 893
Mailing Address - Street 2:
Mailing Address - City:YORK HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:03911-0893
Mailing Address - Country:US
Mailing Address - Phone:207-450-6565
Mailing Address - Fax:
Practice Address - Street 1:1132 US ROUTE 1
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-5916
Practice Address - Country:US
Practice Address - Phone:207-450-6565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-19
Last Update Date:2017-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC4842101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health