Individual
BARRY L EDITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
189 EXCHANGE ST, 2201A &2201B, BANGOR, ME 04401-6507
(207) 299-4947
Mailing address
PO BOX 2342, 2201A&2201B, BANGOR, ME 04402-2342
(207) 299-4947
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC12264
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
319070099
—
ME
Enumeration date
10/12/2006
Last updated
05/04/2021
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