Bangor Psychiatric Associates, PA

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

BANGOR PSYCHIATRIC ASSOCIATES, PA

Practice address

444 Stillwater Ave Ste 210
Bangor, ME 04401-3500

Phone

(207) 907-4311

Fax

(207) 907-4322

NPI assigned

Nov 28, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Michelle Henneberry, PMHNP

Title

President

Phone

(207) 907-6311

Specialties & licenses 1

Addresses

Other identifiers 2

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Takeo Kawamura, MD

  • Psychiatry Physician
  • Bangor, ME
  • NPI 1124188255

  Psychiatry

  NPD (past)

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291766400000",
    "number": "1740356997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "444 STILLWATER AVE STE 210",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044013500",
            "telephone_number": "207-907-4311",
            "fax_number": "207-907-4322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "444 STILLWATER AVE STE 210",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044013500",
            "telephone_number": "207-907-4311",
            "fax_number": "207-907-4322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BANGOR PSYCHIATRIC ASSOCIATES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2010-12-08",
        "status": "A",
        "authorized_official_last_name": "HENNEBERRY",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "207-907-6311",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PMHNP"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "105740000",
            "state": "ME"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "048918",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bangor Family Health Care
• Bangor Healthcare
• Bangor Mall Eye Association
• Bangor Nursing & Rehabilitation Center
• Bangor Plastic and Hand Surgery, P.a.
• Bangor Surgical Associates, P.a.
• Emily Banks, DPT
• Elizabeth Ann Baratta, MD
• Erin Barker, FNP
• Olivia Paige Barksdale, PA-C

• All providers in Bangor, ME
• Psychiatry Physician in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.