Individual
TIFFANY BEAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
525 MAIN ST, SOUTH PORTLAND, ME 04106-5462
(207) 874-1045
(207) 767-0995
Mailing address
525 MAIN ST, SOUTH PORTLAND, ME 04106-5462
(207) 874-1045
(207) 767-0995
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LC3492
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
434785999
—
ME
Enumeration date
10/13/2009
Last updated
10/13/2009
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