Provider Demographics
NPI:1437401262
Name:BONNIE I HANDY LCSW LADC
Entity type:Organization
Organization Name:BONNIE I HANDY LCSW LADC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:HANDY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LADC
Authorized Official - Phone:207-653-1371
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:ME
Mailing Address - Zip Code:04039-0160
Mailing Address - Country:US
Mailing Address - Phone:207-653-1371
Mailing Address - Fax:
Practice Address - Street 1:57 TANDBERG TRL
Practice Address - Street 2:SUITE #6
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-6425
Practice Address - Country:US
Practice Address - Phone:207-653-1371
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-03
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC3393101YA0400X
MELC66461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEME1202OtherMEDICARE ID