Provider Demographics
NPI:1861662629
Name:BREWER, BETHANY M (LCSW)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:M
Last Name:BREWER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:B
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:23 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04096
Mailing Address - Country:US
Mailing Address - Phone:207-838-6341
Mailing Address - Fax:877-864-9483
Practice Address - Street 1:23 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04096
Practice Address - Country:US
Practice Address - Phone:207-838-6341
Practice Address - Fax:877-864-9483
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-08
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC109481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical