Provider Demographics
NPI:1063563849
Name:YELCH-WEATHERBEE, JANET MARIE (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:JANET
Middle Name:MARIE
Last Name:YELCH-WEATHERBEE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 512
Mailing Address - Street 2:
Mailing Address - City:DOVER FOXCROFT
Mailing Address - State:ME
Mailing Address - Zip Code:04426-0512
Mailing Address - Country:US
Mailing Address - Phone:207-564-3316
Mailing Address - Fax:
Practice Address - Street 1:27 STATE ST
Practice Address - Street 2:SUITE #66
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5113
Practice Address - Country:US
Practice Address - Phone:207-945-9343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC725101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME24442OtherANTHEM PROVIDER #
MEMM7184Medicare ID - Type UnspecifiedMEDICARE PROVIDER #