Provider Demographics
NPI:1912065343
Name:BEAN, JUDITH ANN (LCSW)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANN
Last Name:BEAN
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:PO BOX 777
Mailing Address - Street 2:
Mailing Address - City:PARSONSFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04047
Mailing Address - Country:US
Mailing Address - Phone:207-625-8126
Mailing Address - Fax:207-625-7820
Practice Address - Street 1:70 MAIN STREET
Practice Address - Street 2:
Practice Address - City:PORTER
Practice Address - State:ME
Practice Address - Zip Code:04068
Practice Address - Country:US
Practice Address - Phone:207-625-8126
Practice Address - Fax:207-625-7820
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC7295104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1408Medicare ID - Type Unspecified