Provider Demographics
NPI:1639126097
Name:REED HANISH, CELESTE V (LCSW)
Entity type:Individual
Prefix:
First Name:CELESTE
Middle Name:V
Last Name:REED HANISH
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 1:21 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:HAMPDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04444-1209
Mailing Address - Country:US
Mailing Address - Phone:207-478-1562
Mailing Address - Fax:207-862-5393
Practice Address - Street 1:319 UNION ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-4607
Practice Address - Country:US
Practice Address - Phone:207-478-1562
Practice Address - Fax:207-862-5393
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC6917104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME098304OtherANTHEM LEGACY NUMBER
MEMM8860Medicare ID - Type UnspecifiedMEDICARE PROVIDER #