Individual
TINA K BEVERLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW-CC
Contact information
Practice address
442 MOOSEHEAD TRL, NEWPORT, ME 04953-4004
(207) 907-7205
(207) 561-4725
Mailing address
29 FRANKLIN ST, BANGOR, ME 04401-4909
(207) 907-7205
(207) 561-4725
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
MC15885
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
IN PROCESS
—
ME
Enumeration date
05/03/2016
Last updated
05/03/2016
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