Organization
BANGOR PSYCHIATRIC ASSOCIATES, PA
Active
Organization
BANGOR PSYCHIATRIC ASSOCIATES, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MICHELLE HENNEBERRY PMHNP (PRESIDENT)
(207) 907-6311
Entity
Organization
Contact information
Practice address
444 STILLWATER AVE STE 210, BANGOR, ME 04401-3500
(207) 907-4311
(207) 907-4322
Mailing address
444 STILLWATER AVE STE 210, BANGOR, ME 04401-3500
(207) 907-4311
(207) 907-4322
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
048918
ANTHEM
ME
05
—
105740000
—
ME
Enumeration date
11/28/2006
Last updated
12/08/2010
Update your record
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