Provider Demographics
NPI:1124355151
Name:ADAMSON, JEAN SUSAN (LCSW)
Entity type:Individual
Prefix:MS
First Name:JEAN
Middle Name:SUSAN
Last Name:ADAMSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:JEAN
Other - Middle Name:SUSAN
Other - Last Name:BERTOLAET
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:21 MAIN ST.
Mailing Address - Street 2:STE 301
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6359
Mailing Address - Country:US
Mailing Address - Phone:207-941-8727
Mailing Address - Fax:207-992-2784
Practice Address - Street 1:12 MARIETTA DRIVE
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:ME
Practice Address - Zip Code:04457-0125
Practice Address - Country:US
Practice Address - Phone:207-941-8727
Practice Address - Fax:207-992-2784
Is Sole Proprietor?:No
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC62061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME325010099Medicaid