Carol Jean Witham – Case Manager/Care Coordinator

Key facts

NPI: 1083928451
Entity type: Individual (NPI type 1)
Primary specialty: Case Manager/Care Coordinator 171M00000X
License: MHRT-C (ME)
Practice address: 273 Hammond St
Bangor, ME 04401-4610
Phone: (207) 217-6711
Fax: (207) 217-6712
NPI assigned: Jul 28, 2010
Sex: Female
Sole proprietor: Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Making the Impossible Possible Case Management Case Management Agency · Bangor, ME · NPI 1629382726

NPD (past) Authorized official

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
MHRT-C	ME	MD	Case Manager/Care Coordinator

Practice roles

Organization	Specialty	Status	New patients
Making the Impossible Possible Case Management		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Case Manager/Care Coordinator	171M00000X	MHRT-C	ME	Yes

Addresses

Primary practice location

273 Hammond St
Bangor, ME 04401-4610

Mailing address

273 Hammond St
Bangor, ME 04401-4610
Phone (207) 217-6711

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 1, 2010.

{
    "created_epoch": "1280275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285891200000",
    "number": "1083928451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "273 HAMMOND ST",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044014610",
            "telephone_number": "207-217-6711",
            "fax_number": "207-217-6712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "273 HAMMOND ST",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044014610",
            "telephone_number": "207-217-6711",
            "fax_number": "207-217-6712"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WITHAM",
        "first_name": "CAROL",
        "middle_name": "JEAN",
        "name_prefix": "Ms.",
        "credential": "MHRT-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-07-28",
        "last_updated": "2010-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "ME",
            "license": "MHRT-C",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bangor, ME

All providers in Bangor, ME · Case Manager/Care Coordinator in Maine

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 1, 2010. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.