NPIMap

Individual provider Active NPI

Barry L Edith, LCSW

  • Clinical Social Worker
  • Bangor, ME
National Provider Identifier
1346330487
Registry record updated May 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LC12264 Issued in ME
Practice address
189 Exchange St
2201A &2201B
Bangor, ME 04401-6507
Phone
(207) 299-4947
NPI assigned
Oct 12, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 4, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LC12264 ME Primary

Addresses

Primary practice location

189 Exchange St
2201A &2201B
Bangor, ME 04401-6507

Mailing address

PO Box 2342
2201A&2201B
Bangor, ME 04402-2342
Phone (207) 299-4947

Other practice location 1

1012 Union St
Bangor, ME 04401-3060
Phone (207) 404-8100

Other identifiers 1

IdentifierTypeStateIssuer
319070099MedicaidME

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091217000247 ME Practitioner - Clinical Social Worker 0840330122 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Penobscot Community Health CenterGroup PAC ID 0143212670, 135 clinicians
Health Affiliates Maine, LLCGroup PAC ID 1951594076, 169 clinicians

Practice addresses (Care Compare)

1012 Union St
Bangor, ME 04401-3058

1068 Union St
Bangor, ME 04401-3016
Phone (207) 404-8181

181 Corporate Dr
Bangor, ME 04401-4314
Phone (207) 992-2636

30 Summer St
Bangor, ME 04401-6467
Phone (207) 404-8383

306 Rodman Rd
Auburn, ME 04210-3830
Phone (207) 333-3278

6 Telcom Dr
Bangor, ME 04401-3072
Phone (207) 941-2850

992 Union St
Bangor, ME 04401-3057

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Penobscot Community Health Center Current Accepting new patients
Health Affiliates Maine, LLC CurrentSince May 23, 2018 Accepting new patients
Penobscot Community Health Center CurrentSince Jul 10, 2017 Accepting new patients
Penobscot Community Health Center CurrentSince Jul 10, 2017 Accepting new patients

Locations

306 Rodman Rd
Auburn, ME 04210
Phone (207) 333-3278

992 Union St
Ste 5
Bangor, ME 04401
Phone (207) 992-2601

1012 Union St
Ste 1
Bangor, ME 04401
Phone 2079455247407

1012 Union St
Bangor, ME 04401
Phone (207) 404-8200

Organizations & group practices 15

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.

View all 15

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620086400000",
    "number": "1346330487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2342",
            "address_2": "2201A&2201B",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044022342",
            "telephone_number": "207-299-4947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "189 EXCHANGE ST",
            "address_2": "2201A &2201B",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044016507",
            "telephone_number": "207-299-4947"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1012 Union St",
            "address_purpose": "LOCATION",
            "city": "Bangor",
            "state": "ME",
            "postal_code": "044013060",
            "country_code": "US",
            "telephone_number": "207-404-8100",
            "fax_number": "207-947-0435",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EDITH",
        "first_name": "BARRY",
        "middle_name": "L",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2021-05-04",
        "certification_date": "2021-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ME",
            "license": "LC12264",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "319070099",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bangor, ME

Sources for this page

Verify at the official NPI Registry.