| Doctor Name: | MS. HEIDI SUE BENNETT-PROVENCHER |
| NPI Number: | 1104141175 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CADC |
| License Number: | CAC3731 |
| Business Practice Address: | 235 Main St Norway, ME - 042685943 |
| Business Phone Number: | 2077392644 |
| Business Fax Number: | 2077392467 |
| Mailing Address: | 235 Main St, NORWAY |
| State: | ME |
| Postal Code: | 042685943 |
| Phone Number: | 2077392644 |
| Fax Number: | 2077392467 |
| NPI Enumeration Date: | 04/02/2010 |
| NPI Last Update Date: | 04/02/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | CAC3731 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ME |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |