Provider Demographics
NPI:1821220070
Name:GALIPEAU, BRIAN KEITH (LMSW-CC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:KEITH
Last Name:GALIPEAU
Suffix:
Gender:M
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6508
Mailing Address - Country:US
Mailing Address - Phone:207-941-6434
Mailing Address - Fax:
Practice Address - Street 1:202 EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6508
Practice Address - Country:US
Practice Address - Phone:207-941-6434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC12165104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME434375099OtherMAINECARE