Provider Demographics
NPI:1073671046
Name:CRANDALL, JENNIFER M (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:M
Last Name:CRANDALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 SWEDEN ST
Mailing Address - Street 2:
Mailing Address - City:CARIBOU
Mailing Address - State:ME
Mailing Address - Zip Code:04736-2127
Mailing Address - Country:US
Mailing Address - Phone:207-493-3361
Mailing Address - Fax:207-492-4889
Practice Address - Street 1:24 SWEDEN ST
Practice Address - Street 2:
Practice Address - City:CARIBOU
Practice Address - State:ME
Practice Address - Zip Code:04736-2127
Practice Address - Country:US
Practice Address - Phone:207-493-3361
Practice Address - Fax:207-492-4889
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC136401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME403910099Medicaid