Provider Demographics
NPI:1265205702
Name:WARD, MISTY LYNNE
Entity type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:LYNNE
Last Name:WARD
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MISTY
Other - Middle Name:LYNNE
Other - Last Name:DAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:182 BACK SEARSPORT RD
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-7043
Mailing Address - Country:US
Mailing Address - Phone:207-505-6903
Mailing Address - Fax:
Practice Address - Street 1:877 STILLWATER AVE
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3601
Practice Address - Country:US
Practice Address - Phone:207-245-7654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker