Provider Demographics
NPI:1194954024
Name:CUMMINGS MCGARY, JODI L (LCSW)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:L
Last Name:CUMMINGS MCGARY
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:PO BOX 29
Mailing Address - Street 2:
Mailing Address - City:DOVR FOXCROFT
Mailing Address - State:ME
Mailing Address - Zip Code:04426-0029
Mailing Address - Country:US
Mailing Address - Phone:207-564-3000
Mailing Address - Fax:207-422-7339
Practice Address - Street 1:1048 SOUTH ST
Practice Address - Street 2:
Practice Address - City:DOVER FOXCROFT
Practice Address - State:ME
Practice Address - Zip Code:04426-1232
Practice Address - Country:US
Practice Address - Phone:207-564-3000
Practice Address - Fax:207-422-7339
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC120411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME434479199Medicaid