Provider Demographics
NPI:1063526770
Name:PURINTON, JONATHAN M (LCPC)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:M
Last Name:PURINTON
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:668 OYSTER RIVER RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:ME
Mailing Address - Zip Code:04864-4244
Mailing Address - Country:US
Mailing Address - Phone:297-273-2779
Mailing Address - Fax:209-727-3277
Practice Address - Street 1:668 OYSTER RIVER RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:ME
Practice Address - Zip Code:04864-4244
Practice Address - Country:US
Practice Address - Phone:297-273-2779
Practice Address - Fax:209-727-3277
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC1967101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME2204279OtherCIGNA PIN
ME022946OtherANTHEM BCBS
ME065163OtherMNH PIN
ME7748525OtherAETNA PIN #